Provider Demographics
NPI:1023018827
Name:SABOLOVIC, MICHAEL A (MSPT, MTC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SABOLOVIC
Suffix:
Gender:M
Credentials:MSPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5799 BROADMOOR ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2403
Mailing Address - Country:US
Mailing Address - Phone:913-384-5600
Mailing Address - Fax:913-384-0719
Practice Address - Street 1:5799 BROADMOOR ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2403
Practice Address - Country:US
Practice Address - Phone:913-384-5600
Practice Address - Fax:913-384-0719
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02336225100000X
MO2001018689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
501071OtherPHCS
731060OtherHEALTHCARE PREFERRED
KS650019070OtherMEDICARE RAILROAD
KST66E306OtherMEDICARE B - KS
24598014OtherBLUE CROSS BLUE SHIELD KC
KS43181441066202A002OtherTRICARE - KS
24598OtherPREFERRED HEALTH PROFESS
4000127OtherMULTIPLAN
8271336OtherAETNA
MOT66E306AOtherMEDICARE B - MO
MO43181441064155A004OtherTRICARE - MO
KS534021OtherBLUE CROSS BLUE SHIELD KS
1239683OtherFIRST HEALTH NETWORK
440238OtherHEALTHLINK
24598OtherPREFERRED HEALTH PROFESS