Organization
SERC OF OVERLAND PARK KANSAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY L CORRADO MPT (CLINIC DIRECTOR)
(913) 451-7372
Entity
Organization
Contact information
Practice address
7211 W 110TH ST, OVERLAND PARK, KS 66210-2339
(913) 451-7372
(913) 451-7375
Mailing address
7211 W 110TH ST, OVERLAND PARK, KS 66210-2339
(913) 451-7372
(913) 451-7375
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-03366
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34416028
BCBS
KS
Enumeration date
05/05/2006
Last updated
11/01/2012
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