=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003584657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KANSAS PHYSICAL THERAPY PARTNERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2021
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 E IRON AVE
-----------------------------------------------------
City | SALINA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67401-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-764-0497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 E IRON AVE
-----------------------------------------------------
City | SALINA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67401-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-572-5787
-----------------------------------------------------
Fax | 785-746-0428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PHYSICAL THERAPIST
-----------------------------------------------------
Name | JORDAN ZUCCARELLI
-----------------------------------------------------
Credential | DPT, OCS, CMPT
-----------------------------------------------------
Telephone | 785-572-5787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------