Provider Demographics
NPI:1407864564
Name:DECKER, ANN MARIE (PT, MSA, GCS)
Entity Type:Individual
Prefix:PROF
First Name:ANN
Middle Name:MARIE
Last Name:DECKER
Suffix:
Gender:F
Credentials:PT, MSA, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W 71ST TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1238
Mailing Address - Country:US
Mailing Address - Phone:816-822-1239
Mailing Address - Fax:816-501-4643
Practice Address - Street 1:3100 BROADWAY ST
Practice Address - Street 2:SUITE 507
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2658
Practice Address - Country:US
Practice Address - Phone:816-679-7056
Practice Address - Fax:816-523-0306
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001558822251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics