Provider Demographics
NPI:1902279763
Name:BAUTISTA, LINNE (PT)
Entity Type:Individual
Prefix:
First Name:LINNE
Middle Name:
Last Name:BAUTISTA
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 1:12942 WORNALL RD
Mailing Address - Street 2:REHAB CARE - KANSAS CITY, MO
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1253
Mailing Address - Country:US
Mailing Address - Phone:816-942-6705
Mailing Address - Fax:
Practice Address - Street 1:12942 WORNALL RD
Practice Address - Street 2:REHAB CARE - KANSAS CITY, MO
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1253
Practice Address - Country:US
Practice Address - Phone:816-942-6705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015036161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist