Provider Demographics
NPI:1811082159
Name:BLUE VALLEY PHYSICAL THERAPY,PA
Entity type:Organization
Organization Name:BLUE VALLEY PHYSICAL THERAPY,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD-COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-897-1100
Mailing Address - Street 1:6885 W 151ST ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2507
Mailing Address - Country:US
Mailing Address - Phone:913-897-1100
Mailing Address - Fax:913-897-9696
Practice Address - Street 1:6885 W 151ST ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2507
Practice Address - Country:US
Practice Address - Phone:913-897-1100
Practice Address - Fax:913-897-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS176546Medicare Oscar/Certification