Healthcare Provider Details

I. General information

NPI: 1538375225
Provider Name (Legal Business Name): MRS. GWEN OYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E FULTON ST
GARDEN CITY KS
67846-5455
US

IV. Provider business mailing address

101 E FULTON ST
GARDEN CITY KS
67846-5455
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-8400
  • Fax: 620-275-2687
Mailing address:
  • Phone: 620-275-8400
  • Fax: 620-275-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1400668
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: