Active NPI
Elizabeth A Daze, PT, DPT
- Physical Therapist
- Mission, KS
National Provider Identifier
1104865997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1103763
- Practice address
- 6640 Johnson Dr
Mission, KS 66202-2617 - Phone
- (913) 384-5810
- Fax
- (913) 384-0719
- NPI assigned
- Jun 6, 2006
- Last updated
- Nov 21, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2006021634 | MO | |
| Physical Therapist | 225100000X | 1103763 | KS | Primary |
Addresses
Primary practice location
6640 Johnson Dr
Mission, KS 66202-2617
Mailing address
6397 Lee Hwy Ste 300
Chattanooga, TN 37421-2564
Phone (423) 238-7217
Other names 1
- Elizabeth A Schukman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1103763 | KS | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spine and Extremity Rehabilitation Center of Raytown Inc | Physical Therapist | Past | Accepting new patients |
| Mid America Balance Institute of Cass County Missouri | Past | Accepting new patients | |
| Serc of Johnson County LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba SERC of Olathe; SERC of Shawnee
- Physical Therapist
- Olathe, KS
- NPI 1952359390
-
dba MABI of Cass County
- Respiratory/Developmental/Rehabilitative Specialist/Technologist
- Belton, MO
- NPI 1902050511
-
dba SERC of Raytown; SERC of South Raytown; SERC of Belton
- Physical Therapist
- Raytown, MO
- NPI 1568410165
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511222400000",
"number": "1104865997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6397 LEE HWY STE 300",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374212564",
"telephone_number": "423-238-7217",
"fax_number": "423-238-3473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6640 JOHNSON DR",
"city": "MISSION",
"state": "KS",
"postal_code": "662022617",
"telephone_number": "913-384-5810",
"fax_number": "913-384-0719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAZE",
"first_name": "ELIZABETH",
"middle_name": "A",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-06",
"last_updated": "2017-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2006021634",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "1103763",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ELIZABETH",
"last_name": "SCHUKMAN",
"middle_name": "A",
"credential": "DPT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mission, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.