Provider Demographics
NPI:1033737788
Name:MOYER, CLARA PHILLIPS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:PHILLIPS
Last Name:MOYER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:JORDAN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10851 STATE LINE RD APT 5
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4807
Mailing Address - Country:US
Mailing Address - Phone:573-424-4644
Mailing Address - Fax:
Practice Address - Street 1:5100 INDIAN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-4115
Practice Address - Country:US
Practice Address - Phone:913-544-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6698225100000X
KS11-06506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPT-6698OtherIDAHO DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSES
KS11-06506OtherKANSAS BOARD OF HEALING ARTS