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General NPI Number Information
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NPI Number | 1396844874
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Entity Type | Organization
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Legal Business Name | SOUTHEAST KANSAS ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 1623 S MAIN ST
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City | FORT SCOTT
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State | KS
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Zip | 66701-2656
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Country | US
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Telephone | 620-223-4555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14
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City | FORT SCOTT
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State | KS
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Zip | 66701-0014
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Country | US
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Telephone | 620-223-4555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM B. ALLEN
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Credential | PT
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Telephone | 620-223-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-02934
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 24-00361
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License Number State | KS
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