Individual
DYLAN ANTHONY PADBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
14802 SHAMROCK WAY STE C, SMITHVILLE, MO 64089-8381
(816) 873-1101
(816) 399-5796
Mailing address
6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-2564
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1103880
KS
225100000X
Physical Therapist
Primary
2008032777
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730336314
BCBS KS
KS
01
—
41645082
BCBS KC
—
01
—
KA2868007
MEDICARE PTAN
KS
01
—
MA4370046
MEDICARE PTAN
MO
Enumeration date
08/26/2008
Last updated
05/08/2018
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