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General NPI Number Information
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NPI Number | 1720089774
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Entity Type | Organization
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Legal Business Name | NORTHWEST KANSAS PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 421 MAIN ST
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City | STOCKTON
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State | KS
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Zip | 67669-1929
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Country | US
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Telephone | 785-415-2378
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Fax | 785-415-2379
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Provider Business Mailing Address
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Address Line | 421 MAIN ST
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City | STOCKTON
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State | KS
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Zip | 67669-1929
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Country | US
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Telephone | 785-415-2378
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Fax | 785-415-2379
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MRS. DAWN LARAE STEPHENS
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Credential | PT
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Telephone | 785-415-2378
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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 | LLC NO. 3598190
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License Number State | KS
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