Healthcare Provider Details

I. General information

NPI: 1396200663
Provider Name (Legal Business Name): MOVE2PLAY PEDIATRIC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9229 E 37TH ST N STE 201
WICHITA KS
67226-2003
US

IV. Provider business mailing address

301 S MERIDIAN AVE RM 113
WICHITA KS
67213-2629
US

V. Phone/Fax

Practice location:
  • Phone: 316-655-3403
  • Fax: 316-247-8191
Mailing address:
  • Phone: 316-655-3403
  • Fax: 316-247-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: VALERIE C SKENDER
Title or Position: OWNER
Credential: OTR
Phone: 316-655-3403