Individual
LISA JO BOUDRIEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
12000 W 110TH ST, SUITE 400, OVERLAND PARK, KS 66210-3938
(816) 679-7056
(816) 523-0306
Mailing address
4629 W 72ND TER, PRAIRIE VILLAGE, KS 66208-2827
(913) 831-6242
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3604
KS
Other
Enumeration date
08/01/2006
Last updated
07/08/2007
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