Healthcare Provider Details

I. General information

NPI: 1487741112
Provider Name (Legal Business Name): CHERYL R JABARA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 E 29TH STREET NORTH
WICHITA KS
67226-2169
US

IV. Provider business mailing address

8700 E 29TH STREET NORTH
WICHITA KS
67226-2169
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-8710
  • Fax: 316-634-8850
Mailing address:
  • Phone: 316-634-8710
  • Fax: 316-634-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1103391
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1103391
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: