Healthcare Provider Details

I. General information

NPI: 1437273893
Provider Name (Legal Business Name): REHABVISIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S CLARK AVE
LYONS KS
67554-3003
US

IV. Provider business mailing address

507 S DOUGLAS AVE
LYONS KS
67554-3201
US

V. Phone/Fax

Practice location:
  • Phone: 620-257-5173
  • Fax:
Mailing address:
  • Phone: 620-257-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number14-01142
License Number StateKS

VIII. Authorized Official

Name: MR. SHAWN DEAN STOCKMAN
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential:
Phone: 620-257-5173