Provider Demographics
NPI:1255697108
Name:KC REHAB DOCTORS LLC
Entity type:Organization
Organization Name:KC REHAB DOCTORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LADESICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-207-2189
Mailing Address - Street 1:13103 W 54TH TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-4716
Mailing Address - Country:US
Mailing Address - Phone:913-515-8826
Mailing Address - Fax:
Practice Address - Street 1:2555 NORTERRE CIR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3412
Practice Address - Country:US
Practice Address - Phone:816-479-4793
Practice Address - Fax:913-825-6358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006007778208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty