Provider Demographics
NPI:1356324065
Name:PRIM, KAYE R (LPT)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:R
Last Name:PRIM
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 S SANTA FE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4162
Mailing Address - Country:US
Mailing Address - Phone:785-825-1361
Mailing Address - Fax:785-823-7077
Practice Address - Street 1:521 S SANTA FE AVE
Practice Address - Street 2:STE A
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4162
Practice Address - Country:US
Practice Address - Phone:785-825-1361
Practice Address - Fax:785-823-7077
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140572Medicare ID - Type Unspecified
P94195Medicare UPIN
KS6878OtherPREFERRED HEALTH SYSTEM
KS203477OtherHEALTH PARTNERS
KS465267OtherCHILDREN'S MERCY
P00220055OtherR.R. MEDICARE