Provider Demographics
NPI:1649764077
Name:LEBLANC, ADAM LEE (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:LEE
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-1200
Mailing Address - Country:US
Mailing Address - Phone:913-945-2153
Mailing Address - Fax:913-945-2154
Practice Address - Street 1:13800 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-1200
Practice Address - Country:US
Practice Address - Phone:913-945-2153
Practice Address - Fax:913-945-2154
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS176575OtherMEDICARE OSCAR/CERTIFICATION
KS175541OtherMEDICARE OSCAR/CERTIFICATION
KS17E469Medicaid