Provider Demographics
NPI:1356656730
Name:SHEAHON, KIMBERLEE ANN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:ANN
Last Name:SHEAHON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KIMBERLEE
Other - Middle Name:ANN
Other - Last Name:RAUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3980 E JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2205
Mailing Address - Country:US
Mailing Address - Phone:816-795-1433
Mailing Address - Fax:
Practice Address - Street 1:3980 E JACKSON DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2205
Practice Address - Country:US
Practice Address - Phone:816-795-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010025924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist