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General NPI Number Information
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NPI Number | 1013948975
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Entity Type | Organization
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Legal Business Name | ADVANCED THERAPY & SPORTS MEDICINE, CHARTERED
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 4801 10TH ST
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City | GREAT BEND
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State | KS
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Zip | 67530-3252
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Country | US
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Telephone | 620-792-7868
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 10TH ST
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City | GREAT BEND
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State | KS
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Zip | 67530-3542
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Country | US
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Telephone | 620-792-7868
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERESA MALONE
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Credential | PT
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Telephone | 620-792-7868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 261QP2000X
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License Number State | KS
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