Provider Demographics
NPI:1205671351
Name:SPARE, LYNN ELLEN (PTA)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ELLEN
Last Name:SPARE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10880 BENSON DR STE 2370
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1599
Mailing Address - Country:US
Mailing Address - Phone:816-255-9729
Mailing Address - Fax:
Practice Address - Street 1:10422 S OUTER BELT RD
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-9085
Practice Address - Country:US
Practice Address - Phone:816-255-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02148225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant