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General NPI Number Information
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NPI Number | 1255493334
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Entity Type | Organization
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Legal Business Name | SUN LAKES PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 204 SEMINARY ST
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City | WARSAW
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State | MO
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Zip | 65355
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Country | US
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Telephone | 660-438-6993
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Fax | 660-438-6943
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Provider Business Mailing Address
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Address Line | PO BOX 383
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City | WARSAW
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State | MO
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Zip | 65355-0383
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Country | US
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Telephone | 660-438-6993
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Fax | 660-438-6943
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT CHAPMAN
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Credential |
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Telephone | 660-438-6993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 01989
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License Number State | MO
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