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General NPI Number Information
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NPI Number | 1760690861
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Entity Type | Individual
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Provider Name | MARY K. NOLLER P.T.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 929 N SAINT FRANCIS ST
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City | WICHITA
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State | KS
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Zip | 67214-3821
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Country | US
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Telephone | 316-268-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 1504 S SPRINGHOLLOW CIR
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City | WICHITA
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State | KS
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Zip | 67230-9100
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Country | US
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Telephone | 316-733-1125
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 11-00732
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License Number State | KS
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