Healthcare Provider Details

I. General information

NPI: 1699005645
Provider Name (Legal Business Name): PREMIER PHYSICAL THERAPY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8541 W 21ST ST N
WICHITA KS
67205-1753
US

IV. Provider business mailing address

8541 W 21ST ST N
WICHITA KS
67205-1753
US

V. Phone/Fax

Practice location:
  • Phone: 316-613-3068
  • Fax: 316-613-3774
Mailing address:
  • Phone: 316-613-3068
  • Fax: 316-613-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1102091
License Number StateKS

VIII. Authorized Official

Name: JAY FRANZ
Title or Position: OWNER/CLINICAL MANAGER
Credential: PT
Phone: 316-613-3068