MEDICARE: ACTION PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1235766023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTION PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	200 MAIN ST
Second Line	:
City	:	HALSTEAD
State	:	KS
Zip	:	67056-1913
Country	:	US
Telephone Number	:	316-835-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MAIN ST
Second Line	:
City	:	HALSTEAD
State	:	KS
Zip	:	67056-1913
Country	:	US
Telephone Number	:	316-835-7013
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RYAN COOK
Credential	:	PT
Telephone Number	:	316-835-7013

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	10/13/2020

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Directions to “ACTION PHYSICAL THERAPY ” Practice Location

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