Healthcare Provider Details

I. General information

NPI: 1407850902
Provider Name (Legal Business Name): PHYSICAL & RESPIRATORY THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 OREGON ST
HIAWATHA KS
66434-2205
US

IV. Provider business mailing address

819 OREGON ST
HIAWATHA KS
66434-2205
US

V. Phone/Fax

Practice location:
  • Phone: 785-742-2201
  • Fax: 785-742-2202
Mailing address:
  • Phone: 785-742-2201
  • Fax: 785-742-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRELL A METCALF
Title or Position: CFO/VICE PRESIDENT
Credential:
Phone: 800-334-6027