Healthcare Provider Details

I. General information

NPI: 1609511559
Provider Name (Legal Business Name): CALE PRESTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 N SOCORA ST STE 1
WICHITA KS
67212-3278
US

IV. Provider business mailing address

200 W DOUGLAS AVE STE 250
WICHITA KS
67202-3002
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-3731
  • Fax: 316-440-3741
Mailing address:
  • Phone: 316-263-0003
  • 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:
Title or Position:
Credential:
Phone: