Provider Demographics
NPI:1144350570
Name:DETTMANN, JANE A (BSPT)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:A
Last Name:DETTMANN
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:A
Other - Last Name:BURRUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSPT
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-6116
Mailing Address - Fax:785-354-5166
Practice Address - Street 1:1500 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1301
Practice Address - Country:US
Practice Address - Phone:785-354-6116
Practice Address - Fax:785-354-5166
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100079360CMedicaid