Provider Demographics
NPI:1801002035
Name:SERC OF JOHNSON COUNTY, L.L.C.
Entity Type:Organization
Organization Name:SERC OF JOHNSON COUNTY, L.L.C.
Other - Org Name:SERC OF OLATHE, SERC OF SHAWNEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANAGER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:913-782-7734
Mailing Address - Street 1:13095 S MUR LEN RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1230
Mailing Address - Country:US
Mailing Address - Phone:913-782-7733
Mailing Address - Fax:913-782-7209
Practice Address - Street 1:13095 S MUR LEN RD
Practice Address - Street 2:SUITE 170
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1230
Practice Address - Country:US
Practice Address - Phone:913-782-7733
Practice Address - Fax:913-782-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST290000Medicare ID - Type UnspecifiedJOCO MEDICARE