Dr. Sam Allen Detwiler, MD, ATC
Physical Medicine & Rehabilitation in Kansas City, KS. Individual provider (NPI-1).
NPI number1871025767
StatusActive
Last updated in NPPESJun 13, 2024
Details
- NPI
- 1871025767
- Entity type
- Individual (NPI-1)
- Name
- Dr. Sam Allen Detwiler
- Credential
- MD, ATC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 30, 2017
- Certification date
- Jun 13, 2024
- Last updated
- Jun 13, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | 94-11926 | KS | Yes |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | AT8023 | TX |
Practice location
3901 Rainbow Blvd # Ms 2027Kansas City, KS 66160-0006
Phone 913-588-3974
Mailing address
3901 Rainbow Blvd # Ms 1046Kansas City, KS 66160-8500
Other practice locations
3901 Rainbow Blvd # Ms 1046
Kansas City, KS 66160-0006
Kansas City, KS 66160-0006
Phone 913-588-6777 · Fax 913-588-6765
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