Provider Demographics
NPI:1043729510
Name:ADAMS, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 LAUREN LN
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-7665
Mailing Address - Country:US
Mailing Address - Phone:785-224-0830
Mailing Address - Fax:
Practice Address - Street 1:12220 BLUE RIDGE EXT STE A
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1175
Practice Address - Country:US
Practice Address - Phone:816-763-1755
Practice Address - Fax:816-763-1755
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03239225200000X
MO2017030469225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant