Basic Information
| Provider Information | |||||||||
| NPI: | 1043729510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | LAURA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 LAUREN LN | ||||||||
| Address2: | |||||||||
| City: | KEARNEY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640607665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852240830 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12220 BLUE RIDGE EXT STE A | ||||||||
| Address2: | |||||||||
| City: | GRANDVIEW | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640301175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167631755 | ||||||||
| FaxNumber: | 8167631755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2017 | ||||||||
| LastUpdateDate: | 09/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 14-03239 | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2017030469 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.