Provider Demographics
NPI:1790049757
Name:HOLLENBECK, GREGORY KENNETH (DPT)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KENNETH
Last Name:HOLLENBECK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9506 NALL AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2950
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:9506 NALL AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-2950
Practice Address - Country:US
Practice Address - Phone:913-912-1096
Practice Address - Fax:913-912-1157
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017901225100000X
KS1104905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376017857001Medicaid
IL141313Medicare Oscar/Certification
KSKA2468003Medicare PIN