Basic Information
| Provider Information | |||||||||
| NPI: | 1679659353 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | SANDQUIST | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 COLLEGE BLVD | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134517372 | ||||||||
| FaxNumber: | 9134517375 | ||||||||
| Practice Location | |||||||||
| Address1: | 6600 COLLEGE BLVD | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134517372 | ||||||||
| FaxNumber: | 9134517375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 11/27/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11-03673 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2006038289 | MO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 37719018 | 01 | KS | BCBS | OTHER |