Provider Demographics
NPI:1982854899
Name:MICHAELIS, LARISSA L (PT)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:L
Last Name:MICHAELIS
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 1:8610 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1426
Mailing Address - Country:US
Mailing Address - Phone:816-217-4406
Mailing Address - Fax:
Practice Address - Street 1:8610 MEADOW LN
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1426
Practice Address - Country:US
Practice Address - Phone:816-217-4406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-27
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist