Provider Demographics
NPI:1134555162
Name:DUVALL, JESSICA M (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:DUVALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5250 W 94TH TER
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2502
Mailing Address - Country:US
Mailing Address - Phone:913-345-1997
Mailing Address - Fax:913-345-1990
Practice Address - Street 1:5250 W 94TH TER
Practice Address - Street 2:SUITE 200
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2502
Practice Address - Country:US
Practice Address - Phone:913-345-1997
Practice Address - Fax:913-345-1990
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-046652251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics