Provider Demographics
NPI:1356384366
Name:BIRD, KEVIN (PT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:BIRD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 N 976TH RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-9404
Mailing Address - Country:US
Mailing Address - Phone:785-748-0754
Mailing Address - Fax:
Practice Address - Street 1:535 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2342
Practice Address - Country:US
Practice Address - Phone:785-331-0106
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS29375011OtherBCBSKC
KS140149OtherBCBSKS
KS140149OtherBCBSKS