Provider Demographics
NPI:1174758593
Name:STENSRUD, MATTHEW KENT (DPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:KENT
Last Name:STENSRUD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7450 KESSLER ST STE 140
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2519
Mailing Address - Country:US
Mailing Address - Phone:913-362-8317
Mailing Address - Fax:913-362-0169
Practice Address - Street 1:8889 W 75TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2206
Practice Address - Country:US
Practice Address - Phone:913-322-7828
Practice Address - Fax:913-362-0169
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5909225100000X
KS11-03874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201138400AMedicaid
KS201138400AMedicaid
KS255000008Medicare PIN