Provider Demographics
NPI:1861610214
Name:GINES, VICKI D (PT, DPT)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:D
Last Name:GINES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:D
Other - Last Name:LANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6908 N BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-9589
Mailing Address - Country:US
Mailing Address - Phone:816-415-4092
Mailing Address - Fax:816-415-3671
Practice Address - Street 1:2800 CLAY EDWARDS DR
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3220
Practice Address - Country:US
Practice Address - Phone:816-691-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003007584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist