Active NPI
Lane Jeremiah, DPT
- Physical Therapist
- Kansas City, MO
National Provider Identifier
1457073041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5015
- Practice address
- 200 Southwest Blvd
Kansas City, MO 64108-2019 - Phone
- (816) 842-1146
- NPI assigned
- Sep 12, 2022
- Sex
- Male
- 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 | CP014856T | MO | |
| Physical Therapist | 225100000X | 5015 | AR | Primary |
Addresses
Primary practice location
200 Southwest Blvd
Kansas City, MO 64108-2019
Mailing address
2006 Brookhaven Dr
Alma, AR 72921-5012
Phone (479) 739-4485
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5015 | AR | MD | Physical Therapist |
| CP014856T | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662940800000",
"number": "1457073041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2006 BROOKHAVEN DR",
"city": "ALMA",
"state": "AR",
"postal_code": "729215012",
"telephone_number": "479-739-4485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 SOUTHWEST BLVD",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641082019",
"telephone_number": "816-842-1146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEREMIAH",
"first_name": "LANE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-12",
"last_updated": "2022-09-12",
"certification_date": "2022-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "CP014856T",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "5015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.