MEDICARE: LIVING AT HOME 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	225100000X	Physical Therapist	11-00855	KS

General Provider Information

NPI Number	:	1366869547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING AT HOME LLC

Provider Business Mailing Address
First Line	:	13610 N MENNONITE RD
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-9144
Country	:	US
Telephone Number	:	620-271-8674
Fax Number	:

Provider Business Practice Location Address
First Line	:	13610 N MENNONITE RD
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-9144
Country	:	US
Telephone Number	:	620-271-8674
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	BRENDA DREES
Credential	:	PT
Telephone Number	:	620-271-8674

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	03/25/2014

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Directions to “LIVING AT HOME LLC ” Practice Location

Language	Start Address	Practice Location

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