Basic Information
| Provider Information | |||||||||
| NPI: | 1013120575 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WETTERER | ||||||||
| FirstName: | ANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 99TH TERRACE | ||||||||
| Address2: | 111 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64114 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10300 W 103RD ST. | ||||||||
| Address2: | 300 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138941910 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2007008877 | 01 | MO | PHYSICAL THERAPIST | OTHER |