Provider Demographics
NPI:1881209609
Name:PAMPOLINA, PATRICIA A (DPT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:PAMPOLINA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NE TUDOR RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5600
Mailing Address - Country:US
Mailing Address - Phone:816-607-3747
Mailing Address - Fax:
Practice Address - Street 1:8550 MARSHALL DR STE 210
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-9836
Practice Address - Country:US
Practice Address - Phone:913-492-0333
Practice Address - Fax:913-492-0334
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06619225100000X
MO2020025767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist