Healthcare Provider Details
I. General information
NPI: 1205190295
Provider Name (Legal Business Name): APT WEST WICHITA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/25/2012
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
834 N SOCORA ST STE 1
WICHITA KS
67212-3279
US
IV. Provider business mailing address
200 W DOUGLAS AVE STE 1040
WICHITA KS
67202-3013
US
V. Phone/Fax
- Phone: 316-440-3731
- Fax: 316-440-3741
- Phone: 316-263-0003
- Fax: 316-263-1241
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225X00000X |
| Taxonomy | Occupational Therapist |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 332B00000X |
| Taxonomy | Durable Medical Equipment & Medical Supplies |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
DAVID
C
TODD
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: MPT
Phone: 316-263-0003