Individual
RAFAEL CISNEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
377 NW JASPER ST, DALLAS, OR 97338-1279
(913) 953-1220
Mailing address
11820 W 100TH TER, OVERLAND PARK, KS 66214-2441
(913) 953-1220
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
2018026092
MO
225200000X
Physical Therapy Assistant
Primary
CP000275A
OR
Other
Enumeration date
06/04/2019
Last updated
06/04/2019
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