Provider Demographics
NPI:1740273218
Name:NORTHLAND PHYSICAL THERAPY & REHAB SERVICES, INC
Entity type:Organization
Organization Name:NORTHLAND PHYSICAL THERAPY & REHAB SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RVP
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:913-242-7337
Mailing Address - Street 1:2100 SWIFT AVE
Mailing Address - Street 2:
Mailing Address - City:N KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116
Mailing Address - Country:US
Mailing Address - Phone:816-474-8877
Mailing Address - Fax:816-474-8878
Practice Address - Street 1:2100 SWIFT AVE
Practice Address - Street 2:
Practice Address - City:N KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116
Practice Address - Country:US
Practice Address - Phone:816-474-8877
Practice Address - Fax:816-474-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q790000Medicare PIN