Healthcare Provider Details

I. General information

NPI: 1366538191
Provider Name (Legal Business Name): ADVANCED PT MCPHERSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 4TH ST
MCPHERSON KS
67460-2306
US

IV. Provider business mailing address

200 W DOUGLAS STE 1040
WICHITA KS
67200-3017
US

V. Phone/Fax

Practice location:
  • Phone: 620-241-4201
  • Fax: 620-241-4210
Mailing address:
  • Phone: 316-263-0003
  • Fax: 316-263-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-01456
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DAVID C TODD
Title or Position: OWNER
Credential: P.T.
Phone: 316-260-6869