Provider Demographics
NPI:1447377486
Name:RIORDAN, KEVIN PAUL (PT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:PAUL
Last Name:RIORDAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6826 ACUFF ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2107
Mailing Address - Country:US
Mailing Address - Phone:913-268-4007
Mailing Address - Fax:913-993-9149
Practice Address - Street 1:6826 ACUFF ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-2107
Practice Address - Country:US
Practice Address - Phone:913-268-4007
Practice Address - Fax:913-993-9149
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02212171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor