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General NPI Number Information
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NPI Number | 1851750145
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Entity Type | Organization
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Legal Business Name | PROVIDENCE PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 3737 W CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67203-4925
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Country | US
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Telephone | 316-445-0553
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Fax | 316-221-2528
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Provider Business Mailing Address
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Address Line | 10014 W HASKELL CT
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City | WICHITA
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State | KS
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Zip | 67209-3006
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Country | US
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Telephone | 316-448-0553
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Fax | 316-221-2528
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Authorized Official
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Title or Position | OWNER
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Name | HOWARD CHRISTOPHER DECK
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Credential | PT
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Telephone | 316-833-6675
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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 | 11-03608
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License Number State | KS
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