Provider Demographics
NPI:1265091565
Name:RIEPE, KIRK B (DPT, ATC)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:B
Last Name:RIEPE
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13818 S PFLUMM RD APT 206
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-5899
Mailing Address - Country:US
Mailing Address - Phone:316-833-8049
Mailing Address - Fax:
Practice Address - Street 1:1615 PARKER AVE
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-1703
Practice Address - Country:US
Practice Address - Phone:913-755-4165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist