Healthcare Provider Details

I. General information

NPI: 1295821023
Provider Name (Legal Business Name): ADVANCED PHYSICAL THERAPY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 E CENTRAL AVE STE A
WICHITA KS
67208-3915
US

IV. Provider business mailing address

200 W. DOUGLAS AVE STE 1040
WICHITA KS
67208-3915
US

V. Phone/Fax

Practice location:
  • Phone: 316-260-6869
  • Fax: 316-260-6872
Mailing address:
  • Phone: 316-263-0003
  • Fax: 316-263-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID C TODD
Title or Position: OWNER
Credential: P.T.
Phone: 316-260-6869