Provider Demographics
NPI:1073285300
Name:DOOLITTLE, JEFFREY (DPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:DOOLITTLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WOODLAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-8799
Mailing Address - Country:US
Mailing Address - Phone:620-223-7073
Mailing Address - Fax:
Practice Address - Street 1:1410 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3529
Practice Address - Country:US
Practice Address - Phone:785-242-2113
Practice Address - Fax:785-242-2116
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist