Provider Demographics
NPI:1982080651
Name:SARTIN, KEVIN DANIEL (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DANIEL
Last Name:SARTIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E LUCAS ST
Mailing Address - Street 2:
Mailing Address - City:KNOB NOSTER
Mailing Address - State:MO
Mailing Address - Zip Code:65336
Mailing Address - Country:US
Mailing Address - Phone:660-563-9800
Mailing Address - Fax:660-563-9801
Practice Address - Street 1:106 E LUCAS ST
Practice Address - Street 2:
Practice Address - City:KNOB NOSTER
Practice Address - State:MO
Practice Address - Zip Code:65336
Practice Address - Country:US
Practice Address - Phone:660-563-9800
Practice Address - Fax:660-563-9801
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015027234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist