Provider Demographics
NPI:1013959063
Name:BUKATY, KELLY C (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:BUKATY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10701 NALL AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1363
Mailing Address - Country:US
Mailing Address - Phone:913-663-2555
Mailing Address - Fax:913-663-3766
Practice Address - Street 1:10777 NALL AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1362
Practice Address - Country:US
Practice Address - Phone:913-663-2555
Practice Address - Fax:913-663-3766
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS11-03504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist