Provider Demographics
NPI:1104033364
Name:HYDE, ERIC D (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:D
Last Name:HYDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13017 EVERETT CT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-5311
Mailing Address - Country:US
Mailing Address - Phone:913-721-3010
Mailing Address - Fax:
Practice Address - Street 1:8929 PARALLEL PARWAY
Practice Address - Street 2:PROVIDENCE MEDICAL CENTER-REHABILITATION DEPARTMENT
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112
Practice Address - Country:US
Practice Address - Phone:913-596-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02796225100000X
MO106098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist