Provider Demographics
NPI:1952358624
Name:THROCKMORTON, JOHN F III (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:THROCKMORTON
Suffix:III
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 1:9501 N OAK TRFY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2256
Mailing Address - Country:US
Mailing Address - Phone:816-468-5278
Mailing Address - Fax:816-285-5278
Practice Address - Street 1:9501 N OAK TRFY
Practice Address - Street 2:SUITE 201
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2256
Practice Address - Country:US
Practice Address - Phone:816-468-5278
Practice Address - Fax:816-285-5278
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3587225100000X
MO2004023013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS141051OtherBCBS KS
KS176538Medicare ID - Type UnspecifiedMEDICARE