Provider Demographics
NPI:1629609045
Name:MENNINGA, SABRE JEAN
Entity type:Individual
Prefix:
First Name:SABRE
Middle Name:JEAN
Last Name:MENNINGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61299 705TH RD
Mailing Address - Street 2:
Mailing Address - City:BURCHARD
Mailing Address - State:NE
Mailing Address - Zip Code:68323-4039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13420 BRIAR DR STE C
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-3434
Practice Address - Country:US
Practice Address - Phone:402-852-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2025-04-22
Deactivation Date:2020-02-04
Deactivation Code:
Reactivation Date:2024-11-01
Provider Licenses
StateLicense IDTaxonomies
KS11-07747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
937262940572OtherBLUE CROSS