=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316160690
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARK VALLEY PHYSICAL THERAPY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 09/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2524 N SUMMIT ST
-----------------------------------------------------
City | ARKANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67005-8808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-442-0255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2524 NORTH SUMMIT
-----------------------------------------------------
City | ARKANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-442-0255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CINDY MINKLER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 620-442-0255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 11-01584
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------