Provider Demographics
NPI:1669484200
Name:BATTISTE, JEFFREY R (MPT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:R
Last Name:BATTISTE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 N WOODLAWN BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2954
Mailing Address - Country:US
Mailing Address - Phone:316-462-7420
Mailing Address - Fax:316-788-1754
Practice Address - Street 1:1410 N WOODLAWN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2953
Practice Address - Country:US
Practice Address - Phone:316-462-7420
Practice Address - Fax:316-788-1754
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1669484200OtherMEDICARE NPI