Provider Demographics
NPI:1861444549
Name:JANOSE, MARY JO (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:JANOSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5431 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2823
Mailing Address - Country:US
Mailing Address - Phone:816-523-5334
Mailing Address - Fax:
Practice Address - Street 1:5431 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2823
Practice Address - Country:US
Practice Address - Phone:816-523-5334
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00532225100000X
MO00674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
16029026OtherBCBS OF KC MO