Provider Demographics
NPI:1952359390
Name:SERC OF JOHNSON COUNTY LLC
Entity Type:Organization
Organization Name:SERC OF JOHNSON COUNTY LLC
Other - Org Name:SERC OF OLATHE; SERC OF SHAWNEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:913-782-7734
Mailing Address - Street 1:801 N MUR LEN RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1794
Mailing Address - Country:US
Mailing Address - Phone:913-782-7734
Mailing Address - Fax:913-782-7209
Practice Address - Street 1:801 N MUR LEN RD
Practice Address - Street 2:SUITE 111
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1794
Practice Address - Country:US
Practice Address - Phone:913-782-7734
Practice Address - Fax:913-782-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS34414021OtherBCBS
KS34414021OtherBCBS