Provider Demographics
NPI:1770366445
Name:BEDNAR, CAMERON (PT, DPT)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:BEDNAR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15440 TRAILSIDE DR # 104
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-8749
Mailing Address - Country:US
Mailing Address - Phone:913-568-2538
Mailing Address - Fax:
Practice Address - Street 1:1306 PLATTE FALLS RD STE E
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7323
Practice Address - Country:US
Practice Address - Phone:913-568-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023031656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist