Provider Demographics
NPI:1205196342
Name:CRAINE, JESSICA A (DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:CRAINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8434 WARD PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2031
Mailing Address - Country:US
Mailing Address - Phone:816-237-1926
Mailing Address - Fax:816-237-1983
Practice Address - Street 1:8434 WARD PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2031
Practice Address - Country:US
Practice Address - Phone:816-237-1926
Practice Address - Fax:816-237-1983
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS11-04158225100000X
MO2013032376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist