Provider Demographics
NPI:1336715747
Name:OVERMILLER, BLAKE C (DPT)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:C
Last Name:OVERMILLER
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 1:13420 BRIAR DR STE C
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3434
Mailing Address - Country:US
Mailing Address - Phone:913-484-7632
Mailing Address - Fax:913-808-5460
Practice Address - Street 1:13420 BRIAR DR STE C
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-3434
Practice Address - Country:US
Practice Address - Phone:913-484-7632
Practice Address - Fax:913-808-5460
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist