Healthcare Provider Details

I. General information

NPI: 1477224517
Provider Name (Legal Business Name): ICT PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 N OSAGE ST
VALLEY CENTER KS
67147-9580
US

IV. Provider business mailing address

9301 N OSAGE ST
VALLEY CENTER KS
67147-9580
US

V. Phone/Fax

Practice location:
  • Phone: 316-461-0844
  • Fax:
Mailing address:
  • Phone: 316-461-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARA ELLIS
Title or Position: OWNER; DPT
Credential: DPT
Phone: 316-461-0844