Provider Demographics
NPI:1205498284
Name:HUTCHISON, ELLIOT JOHN WILLIAM (DPT)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:JOHN WILLIAM
Last Name:HUTCHISON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 55TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1262
Mailing Address - Country:US
Mailing Address - Phone:816-799-2891
Mailing Address - Fax:
Practice Address - Street 1:17331 E 40 HWY STE 105
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6444
Practice Address - Country:US
Practice Address - Phone:816-478-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06251225100000X
MO2019029568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist