Healthcare Provider Details

I. General information

NPI: 1083390884
Provider Name (Legal Business Name): EVAN MATTHEW WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 MARSHALL DR, STE 210
LENEXA KS
66214
US

IV. Provider business mailing address

200 W. DOUGLAS AVE, STE 250
WICHITA KS
67202
US

V. Phone/Fax

Practice location:
  • Phone: 913-492-0333
  • Fax: 913-492-0334
Mailing address:
  • Phone: 316-263-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberT-05968
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: