Provider Demographics
NPI:1699198473
Name:RICKS, SHAWN CLAYTON (LPTA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:CLAYTON
Last Name:RICKS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 SWOPE PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2638
Mailing Address - Country:US
Mailing Address - Phone:816-924-1122
Mailing Address - Fax:
Practice Address - Street 1:2323 SWOPE PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-2638
Practice Address - Country:US
Practice Address - Phone:816-924-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006001794225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant