Healthcare Provider Details

I. General information

NPI: 1477594208
Provider Name (Legal Business Name): PDS PHYSICAL THERAPY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8620 E 34TH ST N
WICHITA KS
67226-2601
US

IV. Provider business mailing address

8620 E 34TH ST N
WICHITA KS
67226-2601
US

V. Phone/Fax

Practice location:
  • Phone: 316-630-0700
  • Fax: 316-630-0703
Mailing address:
  • Phone: 316-630-0700
  • Fax: 316-630-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11-02091
License Number StateKS

VIII. Authorized Official

Name: MR. JAY FRANZ
Title or Position: PHYSICAL THERAPIST/CLINICAL MANAGER
Credential: P.T.
Phone: 316-630-0700