Provider Demographics
NPI:1104855683
Name:BLUBAUGH, MICHAEL SCOTT (MSPT,LMT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:BLUBAUGH
Suffix:
Gender:M
Credentials:MSPT,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1244
Mailing Address - Country:US
Mailing Address - Phone:913-526-7220
Mailing Address - Fax:
Practice Address - Street 1:211 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076-1135
Practice Address - Country:US
Practice Address - Phone:816-633-4063
Practice Address - Fax:816-230-3230
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01870225100000X
MO117614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist