Provider Demographics
NPI:1942677117
Name:FAST, AARON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:FAST
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 W 88TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1703
Mailing Address - Country:US
Mailing Address - Phone:913-681-9909
Mailing Address - Fax:913-681-9906
Practice Address - Street 1:11301 W 88TH ST
Practice Address - Street 2:STE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1703
Practice Address - Country:US
Practice Address - Phone:913-681-9909
Practice Address - Fax:913-681-9906
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist