Provider Demographics
NPI:1659045599
Name:SCHAFER, NICHOLE KRYSTYNA (PTA)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:KRYSTYNA
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 MCGEE TRFY APT 4309
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3474
Mailing Address - Country:US
Mailing Address - Phone:440-263-4160
Mailing Address - Fax:
Practice Address - Street 1:9701 MONROVIA ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1564
Practice Address - Country:US
Practice Address - Phone:913-492-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03858225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant