Provider Demographics
NPI:1093896979
Name:DEHAN, JAMIE L (PT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:DEHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 NE TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5696
Mailing Address - Country:US
Mailing Address - Phone:816-554-6003
Mailing Address - Fax:816-554-6013
Practice Address - Street 1:294 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5696
Practice Address - Country:US
Practice Address - Phone:816-554-6003
Practice Address - Fax:816-554-6013
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200417370AMedicaid
KSP00375646OtherRETIRED RAILROAD MEDICARE
KS200417370BMedicaid
KSP00375646OtherRETIRED RAILROAD MEDICARE
MOW52E8472AMedicare PIN
KS200417370AMedicaid
MOR99E847Medicare PIN