Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 2013028649 | MO |
Y | 2251P0200X | Physical Therapist - Pediatrics | 2013028649 | MO |
NPI | 1013310523 |
---|---|
Provider Name | Jennifer Chrisco |
First Address | Prairie Village, KS 66206-1355 |
Second Address | Prairie Village, KS 66206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 01/02/2021 |