Provider Demographics
NPI:1578576419
Name:PRYDE, DEBORAH (PFT, MPT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:PRYDE
Suffix:
Gender:F
Credentials:PFT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 NW OLDHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-1520
Mailing Address - Country:US
Mailing Address - Phone:816-347-9696
Mailing Address - Fax:816-347-0020
Practice Address - Street 1:206 NW OLDHAM PKWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1520
Practice Address - Country:US
Practice Address - Phone:816-347-9696
Practice Address - Fax:816-347-0020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5411759OtherFIRST HEALTH
MO31533018OtherBCBS PROVIDER #
MO31533018OtherBCBS PROVIDER #
MO5411759OtherFIRST HEALTH