Healthcare Provider Details

I. General information

NPI: 1194660019
Provider Name (Legal Business Name): DWIGHT HUSTON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W 8TH ST
KINSLEY KS
67547-2329
US

IV. Provider business mailing address

620 W 8TH ST
KINSLEY KS
67547-2329
US

V. Phone/Fax

Practice location:
  • Phone: 620-659-3807
  • Fax:
Mailing address:
  • Phone: 620-659-3807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-00777
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: