Renee Lyn Walczak, RPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11-02133 Issued in KS

Practice address

14112 King St
Overland Park, KS 66221-8004

Phone

(913) 402-0651

NPI assigned

Mar 12, 2008

Last updated

Mar 12, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Renee Lyn Rucker Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205280000000",
    "number": "1376714808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14112 KING ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662218004",
            "telephone_number": "913-402-0651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14112 KING ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662218004",
            "telephone_number": "913-402-0651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALCZAK",
        "first_name": "RENEE",
        "middle_name": "LYN",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-12",
        "last_updated": "2008-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-02133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RENEE",
            "last_name": "RUCKER",
            "middle_name": "LYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Physical Therapist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.