Provider Demographics
NPI:1275061962
Name:DOMKE, ARIANA ADRIENNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ARIANA
Middle Name:ADRIENNE
Last Name:DOMKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 W 103RD ST
Mailing Address - Street 2:STE 22
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2664
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3627 SE 29TH ST STE 107
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2013
Practice Address - Country:US
Practice Address - Phone:785-266-4600
Practice Address - Fax:785-266-4601
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist