MEDICARE: BRYSON KOESTER DPT

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	1107674	KS

General Provider Information

NPI Number	:	1689410409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYSON KOESTER DPT

Provider Business Mailing Address
First Line	:	1819 N GREENWICH RD STE A
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-3103
Country	:	US
Telephone Number	:	316-260-8239
Fax Number	:	316-462-5767

Provider Business Practice Location Address
First Line	:	1819 N GREENWICH RD STE A
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-3103
Country	:	US
Telephone Number	:	316-260-8239
Fax Number	:	316-462-5767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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Directions to “ BRYSON KOESTER DPT” Practice Location

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