=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154582682
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA LEIGH MICHEL D.P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2008
-----------------------------------------------------
Last Update Date | 06/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 W CENTRAL AVE STE 101
-----------------------------------------------------
City | EL DORADO
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67042-2187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-321-2663
-----------------------------------------------------
Fax | 316-321-1194
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 W CENTRAL AVE STE 101
-----------------------------------------------------
City | EL DORADO
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67042-2187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-321-2663
-----------------------------------------------------
Fax | 316-321-1194
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | T-09145
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------