Provider Demographics
NPI:1407903503
Name:WESTERBERG, JENNIFER LEAH (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEAH
Last Name:WESTERBERG
Suffix:
Gender:F
Credentials:PT
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:SUITE 22
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2640
Mailing Address - Country:US
Mailing Address - Phone:913-322-4000
Mailing Address - Fax:913-322-4001
Practice Address - Street 1:10400 W 103RD ST
Practice Address - Street 2:SUITE 22
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-2640
Practice Address - Country:US
Practice Address - Phone:913-322-4000
Practice Address - Fax:913-322-4001
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-036552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00411472OtherRAILROAD MEDICARE
KS37652013OtherKANSAS CITY BLUE CROSS
20588299966214A003OtherTRIWEST
9476424OtherPHCS NETWORK
9476424OtherMULTIPLAN
9476424OtherPHCS NETWORK