MEDICARE: HUMBLE HEALINGS PHYSICAL THERAPY & MASSAGE, LLC

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	261QP2000X	Physical Therapy Clinic/Center	11-03450	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1770560963	OTHER	KS	NPI

General Provider Information

NPI Number	:	1336516152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMBLE HEALINGS PHYSICAL THERAPY & MASSAGE, LLC

Provider Business Mailing Address
First Line	:	119 W 2ND ST
Second Line	:	PO BOX 29
City	:	HALSTEAD
State	:	KS
Zip	:	67056-1604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 W 2ND ST
Second Line	:
City	:	HALSTEAD
State	:	KS
Zip	:	67056-1604
Country	:	US
Telephone Number	:	316-680-8192
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CONNIE HOWARD
Credential	:
Telephone Number	:	316-680-8192

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	08/27/2015

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