Healthcare Provider Details

I. General information

NPI: 1659752475
Provider Name (Legal Business Name): DARRELL SURMEIER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 S RANGE AVE SUITE 1
COLBY KS
67701-3539
US

IV. Provider business mailing address

1000 FIANNA WAY
FORT SMITH AR
72919-9008
US

V. Phone/Fax

Practice location:
  • Phone: 785-465-7444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-01572
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.0013279
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: