Serc of Overland Park Kansas LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11-03366 Issued in KS

Legal business name

SERC OF OVERLAND PARK KANSAS LLC

Practice address

7211 W 110TH St
Overland Park, KS 66210-2339

Phone

(913) 451-7372

Fax

(913) 451-7375

NPI assigned

May 5, 2006

Last updated

Nov 1, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stacey L Corrado, MPTNPI 1255386165

Title

Clinic Director

Phone

(913) 451-7372

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stacey L Corrado, MPT

  • Physical Therapist
  • Overland Park, KS
  • NPI 1255386165
  NPD (past) Authorized official
• Kelly M Meiners, PT

  • Physical Therapist
  • Overland Park, KS
  • NPI 1083669857
  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351728000000",
    "number": "1447208095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7211 W 110TH ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102339",
            "telephone_number": "913-451-7372",
            "fax_number": "913-451-7375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7211 W 110TH ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102339",
            "telephone_number": "913-451-7372",
            "fax_number": "913-451-7375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERC OF OVERLAND PARK KANSAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2012-11-01",
        "status": "A",
        "authorized_official_last_name": "CORRADO",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "913-451-7372",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-03366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "34416028",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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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 Nov 1, 2012; 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.