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General NPI Number Information
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NPI Number | 1790815835
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Entity Type | Individual
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Provider Name | ROBERT C MANSKE PT, DPT, MED, SCS
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 10100 E SHANNON WOODS ST
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City | WICHITA
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State | KS
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Zip | 67226-4103
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Country | US
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Telephone | 316-219-0253
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Fax |
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Provider Business Mailing Address
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Address Line | 2623 W KEYWEST CT
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City | WICHITA
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State | KS
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Zip | 67204-2323
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Country | US
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Telephone | 316-831-0911
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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 | 11-02106
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License Number State | KS
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