Healthcare Provider Details

I. General information

NPI: 1932034568
Provider Name (Legal Business Name): ADAM RUTHERFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MEDICAL CENTER DR STE 300
NEWTON KS
67114-9056
US

IV. Provider business mailing address

1650 S SAINT FRANCIS ST
WICHITA KS
67211-4223
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-7187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-08155
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: