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General NPI Number Information
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NPI Number | 1770778482
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Entity Type | Individual
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Provider Name | KIMBERLY JEAN MATHES P.T.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 10100 SHANNON WOODS
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City | WICHITA
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State | KS
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Zip | 67226
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Country | US
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Telephone | 316-858-1900
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Fax | 316-858-1914
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Provider Business Mailing Address
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Address Line | 621 W 21ST ST
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City | ANDOVER
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State | KS
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Zip | 67002-8498
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-03265
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License Number State | KS
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