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General NPI Number Information
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NPI Number | 1750025516
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Entity Type | Organization
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Legal Business Name | CORE AND RESTORE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 620 N ROCK RD STE 150
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City | DERBY
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State | KS
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Zip | 67037-3585
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Country | US
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Telephone | 316-250-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E STONE CREEK ST
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City | DERBY
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State | KS
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Zip | 67037-9452
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Country | US
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Telephone | 316-210-7567
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATY STRUBLE
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Credential | PT
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Telephone | 316-210-7567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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