Provider Demographics
NPI:1437373297
Name:TROUTMAN, JEANETTE K (PT)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:K
Last Name:TROUTMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4154 W 188TH ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8874
Mailing Address - Country:US
Mailing Address - Phone:913-897-7023
Mailing Address - Fax:
Practice Address - Street 1:2040 HUTTON RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4564
Practice Address - Country:US
Practice Address - Phone:913-321-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00451225100000X
MORO-751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist