Provider Demographics
NPI:1174380638
Name:KIMANI, WILLY (DPT)
Entity type:Individual
Prefix:
First Name:WILLY
Middle Name:
Last Name:KIMANI
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 1:22120 MIDLAND DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3554
Mailing Address - Country:US
Mailing Address - Phone:913-745-4064
Mailing Address - Fax:913-745-4352
Practice Address - Street 1:22120 MIDLAND DR STE 1
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3554
Practice Address - Country:US
Practice Address - Phone:913-745-4064
Practice Address - Fax:913-745-4352
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist