Basic Information
| Provider Information | |||||||||
| NPI: | 1407395015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KROGMEIER | ||||||||
| FirstName: | MARY | ||||||||
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| NameSuffix: | I | ||||||||
| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9127 DARNELL ST | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662153048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138396978 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14809 W 95TH ST | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662155220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138946664 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2017 | ||||||||
| LastUpdateDate: | 02/15/2017 | ||||||||
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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 | 225100000X | 11-04185 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.