Healthcare Provider Details

I. General information

NPI: 1720089774
Provider Name (Legal Business Name): NORTHWEST KANSAS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MAIN ST
STOCKTON KS
67669-1929
US

IV. Provider business mailing address

421 MAIN ST
STOCKTON KS
67669-1929
US

V. Phone/Fax

Practice location:
  • Phone: 785-415-2378
  • Fax: 785-415-2379
Mailing address:
  • Phone: 785-415-2378
  • Fax: 785-415-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLLC NO. 3598190
License Number StateKS

VIII. Authorized Official

Name: MRS. DAWN LARAE STEPHENS
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT
Phone: 785-415-2378