Provider Demographics
NPI:1760105845
Name:DEBOSE, KEYANNA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KEYANNA
Middle Name:
Last Name:DEBOSE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 ABBOTT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-3023
Mailing Address - Country:US
Mailing Address - Phone:913-605-2572
Mailing Address - Fax:
Practice Address - Street 1:6264 LEWIS DR STE 100
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3603
Practice Address - Country:US
Practice Address - Phone:816-587-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1107197225100000X
VACP011884T225100000X
MDCP015406T225100000X
NCP21339225100000X
MOCP017326T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist