Healthcare Provider Details

I. General information

NPI: 1801122254
Provider Name (Legal Business Name): CONNIE JEAN URBANEK CPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 E 21ST ST N COLLEGE HILL NURSING AND REHAB CENTER
WICHITA KS
67208
US

IV. Provider business mailing address

2315 N PARKRIDGE CT
WICHITA KS
67205-2006
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-9291
  • Fax:
Mailing address:
  • Phone: 316-773-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-01126
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: