Provider Demographics
NPI:1437601127
Name:PANEK, MICHAEL EUGENE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:PANEK
Suffix:
Gender:M
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 1:31723 W HARRY ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN PLAIN
Mailing Address - State:KS
Mailing Address - Zip Code:67050-9547
Mailing Address - Country:US
Mailing Address - Phone:316-217-3550
Mailing Address - Fax:
Practice Address - Street 1:13847 W 63RD ST STE 2
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-3800
Practice Address - Country:US
Practice Address - Phone:913-962-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20529225100000X
MO2022049182225100000X
390200000X
KS11-07348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program