Healthcare Provider Details

I. General information

NPI: 1164856977
Provider Name (Legal Business Name): BRITTANY RIAN WEST PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 N KLEIN CIR
DERBY KS
67037-7011
US

IV. Provider business mailing address

601 S EASTRIDGE ST
VALLEY CENTER KS
67147-4715
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-9617
  • Fax:
Mailing address:
  • Phone: 316-807-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-02438
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: