Provider Demographics
NPI:1053938639
Name:VASQUEZ, PAUL CHRISTOPHER (PTA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:CHRISTOPHER
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:CHRISTOPHER
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:12131 W 136TH ST APT 818
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-7523
Mailing Address - Country:US
Mailing Address - Phone:913-313-8311
Mailing Address - Fax:
Practice Address - Street 1:201 E FLAMING RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5343
Practice Address - Country:US
Practice Address - Phone:913-829-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02026225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant