Provider Demographics
NPI:1659095065
Name:HITCHCOCK, DANA (DPT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:HITCHCOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 S 4TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5044
Mailing Address - Country:US
Mailing Address - Phone:913-680-6180
Mailing Address - Fax:913-680-6189
Practice Address - Street 1:3500 S 4TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5044
Practice Address - Country:US
Practice Address - Phone:913-680-6180
Practice Address - Fax:913-680-6189
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist