Provider Demographics
NPI:1710318407
Name:TRINITY REHABILITATION SERVICES
Entity Type:Organization
Organization Name:TRINITY REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:T
Authorized Official - Middle Name:BRET
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:913-634-6844
Mailing Address - Street 1:534 E LOULA ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5402
Mailing Address - Country:US
Mailing Address - Phone:913-634-6844
Mailing Address - Fax:
Practice Address - Street 1:534 E LOULA ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5402
Practice Address - Country:US
Practice Address - Phone:913-634-6844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01516261QP2000X
MO01543261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy