| NPI | 1740313634 |
|---|---|
| Doing Business As | STATE AVENUE THERAPY |
| Entity Type | Organization |
| Authorized Contact | ANGELA MAUCH Director Of Physician Revenue 913-588-6711 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-05-14 |