Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 11-04214 | KS |
N | 225100000X | Physical Therapist | 116072 | MO |
NPI | 1003112038 |
---|---|
Provider Name | Jennifer Jeanne Walawender |
First Address | Overland Park, KS 66211-1363 |
Second Address | Overland Park, KS 66211-1362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2011 |
Last Update Date | 09/02/2011 |