Provider Demographics
NPI:1992922959
Name:DEGHELDER, DAVID MICHAEL (PTA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:DEGHELDER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-2721
Mailing Address - Country:US
Mailing Address - Phone:816-926-0086
Mailing Address - Fax:
Practice Address - Street 1:10560 BARKLEY ST
Practice Address - Street 2:SUITE #330
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1811
Practice Address - Country:US
Practice Address - Phone:913-652-9229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01555225200000X
MO2000167626225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant