Provider Demographics
NPI:1013533702
Name:KNUDSON, MCKAYLA (DPT)
Entity type:Individual
Prefix:DR
First Name:MCKAYLA
Middle Name:
Last Name:KNUDSON
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 1:12452 S GALLERY ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6096
Mailing Address - Country:US
Mailing Address - Phone:913-399-6707
Mailing Address - Fax:816-600-0349
Practice Address - Street 1:12452 S GALLERY ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6096
Practice Address - Country:US
Practice Address - Phone:913-399-6707
Practice Address - Fax:816-600-0349
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist