Provider Demographics
NPI:1467683573
Name:CUELLAR, KATHRYN ROSE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ROSE
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ROSE
Other - Last Name:FAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:8437 STATE AVE
Practice Address - Street 2:STE B
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1842
Practice Address - Country:US
Practice Address - Phone:913-299-9616
Practice Address - Fax:913-299-9617
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist