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General NPI Number Information
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NPI Number | 1013224039
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Entity Type | Individual
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Provider Name | MR. MICHAEL LEROY VINYARD
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Gender | Male
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 930 AMES STREET
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City | BALDWIN CITY
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State | KS
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Zip | 66006
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Country | US
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Telephone | 785-594-4100
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Fax | 785-594-2600
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Provider Business Mailing Address
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Address Line | 1305 WAKARUSA DRIVE
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City | LAWRENCE
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State | KS
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Zip | 66049
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Country | US
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Telephone | 785-842-3444
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Fax | 785-842-3410
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 14-02082
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License Number State | KS
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