Basic Information
Provider Information | |||||||||
NPI: | 1649582933 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALCANTARA | ||||||||
FirstName: | DEBRA | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GREENWOOD | ||||||||
OtherFirstName: | DEBRA | ||||||||
OtherMiddleName: | ELIZABETH | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 17853 SW MEADOWLARK RD | ||||||||
Address2: |   | ||||||||
City: | ROSE HILL | ||||||||
State: | KS | ||||||||
PostalCode: | 671338186 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3162107907 | ||||||||
FaxNumber: | 8339393552 | ||||||||
Practice Location | |||||||||
Address1: | 10000 W 75TH ST | ||||||||
Address2: | SUITE 250 | ||||||||
City: | MERRIAM | ||||||||
State: | KS | ||||||||
PostalCode: | 662042209 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8889131910 | ||||||||
FaxNumber: | 8779131174 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/02/2010 | ||||||||
LastUpdateDate: | 06/15/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/15/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11-04167 | KS | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.