Provider Demographics
NPI:1154860195
Name:WOLLENHAUPT, RON (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:WOLLENHAUPT
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9212 LICHTENAUER DR
Mailing Address - Street 2:APT 539
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-2101
Mailing Address - Country:US
Mailing Address - Phone:913-406-2032
Mailing Address - Fax:
Practice Address - Street 1:2012 10TH AVE
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4207
Practice Address - Country:US
Practice Address - Phone:913-684-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-001762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer