Provider Demographics
NPI:1821705211
Name:OBERKROM, JOEL (CPT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:OBERKROM
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19680 S GREEN RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-8433
Mailing Address - Country:US
Mailing Address - Phone:913-957-2598
Mailing Address - Fax:
Practice Address - Street 1:6700 W 121ST ST STE 300
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2028
Practice Address - Country:US
Practice Address - Phone:913-871-9888
Practice Address - Fax:913-871-1477
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS27305228226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist