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Individual

MRS. LESLIE L RICKETTS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.P.T.

Contact information

Practice address
13157 STATE LINE RD, KANSAS CITY, MO 64145-1650
(816) 941-2550
(816) 941-2520
Mailing address
12728 STATE LINE RD, LEAWOOD, KS 66209
(816) 941-2550
(816) 941-2520

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-03406
KS
225100000X
Physical Therapist
2004024413
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2229370
CCN NETWORK
01
2239593
FIRST HEALTH
01
34387
PREFERRED HEALTH PROFESS
01
34387021
BLUE CROSS BLUE SHIELD KC
MO
Enumeration date
07/22/2005
Last updated
11/22/2019
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