Provider Demographics
NPI:1497370670
Name:HARDER, MICAH KENNETH (DPT)
Entity type:Individual
Prefix:MR
First Name:MICAH
Middle Name:KENNETH
Last Name:HARDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19931 W KELLOGG DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-8864
Mailing Address - Country:US
Mailing Address - Phone:316-550-6132
Mailing Address - Fax:
Practice Address - Street 1:19931 W KELLOGG DR UNIT A
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-8864
Practice Address - Country:US
Practice Address - Phone:316-550-6132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-05290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist