Provider Demographics
NPI:1942491279
Name:VAN DEN BERGHE, ANNAHITA Z (DPT)
Entity Type:Individual
Prefix:
First Name:ANNAHITA
Middle Name:Z
Last Name:VAN DEN BERGHE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNAHITA
Other - Middle Name:
Other - Last Name:ZANDIEHNADEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8434 WARD PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2031
Mailing Address - Country:US
Mailing Address - Phone:816-237-1926
Mailing Address - Fax:816-237-1983
Practice Address - Street 1:15455 S ROGERS RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-3497
Practice Address - Country:US
Practice Address - Phone:913-254-0568
Practice Address - Fax:913-254-0854
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007022415225100000X
KS11-03804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS39074027OtherBCBS
KSQ69000001Medicare PIN