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Individual

BRIAN CONRAD FASSOLD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT, DPT

Contact information

Practice address
7211 W 110TH ST, OVERLAND PARK, KS 66210-2339
(913) 451-7373
(913) 451-7375
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(423) 238-7217

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1104666
KS
225100000X
Physical Therapist
2020010998
MO

Other

Enumeration date
05/08/2013
Last updated
12/08/2021
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