Brian Conrad Fassold, PT, DPT
Individual provider Active NPI Physical Therapist · Overland Park, KS
NPI 1669817359 · NPPES record last updated Dec 8, 2021
Key facts
- NPI
- 1669817359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1104666 (KS)
- Practice address
- 7211 W 110TH St
Overland Park, KS 66210-2339 - Phone
- (913) 451-7373
- Fax
- (913) 451-7375
- NPI assigned
- May 8, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140401001666 | KS | Practitioner - Physical Therapist in Private Practice | 2860623030 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1104666 | KS | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid America Balance Institute Inc | Physical Therapist | Current |
Accepting new patients |
Locations
4801 W 110th St
Ste 100
Overland Park, KS 66211
Phone (816) 246-1456
17134 Bel Ray Pl
Belton, MO 64012
Phone (816) 226-4011
123 NE 91st St
Kansas City, MO 64155
Phone (816) 246-1456
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1104666 | KS | Yes |
| Physical Therapist | 225100000X | 2020010998 | MO |
Addresses
Primary practice location
7211 W 110TH St
Overland Park, KS 66210-2339
Mailing address
1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 238-7217
Other providers in Overland Park, KS
- Kaitlin L Farmerie
- Benjamin Luke Farrell
- Daniel C Farrell
- Kari C Farris
- Zachary D. Fasig
- Aaron Fast
- Sara Fattaey-Gray
- Jennifer Faus
- Mychaela Fawson
- Jessie Nichole Fazel
All providers in Overland Park, KS · Physical Therapist in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.