Healthcare Provider Details

I. General information

NPI: 1982498127
Provider Name (Legal Business Name): TKO PHYSICAL THERAPY & FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W 4TH ST
LEBO KS
66856-9437
US

IV. Provider business mailing address

6288 W 301ST ST
OSAGE CITY KS
66523-9064
US

V. Phone/Fax

Practice location:
  • Phone: 620-794-0532
  • Fax:
Mailing address:
  • Phone: 620-794-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA SUE KIRBY
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 620-794-1611