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General NPI Number Information
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NPI Number | 1891521944
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Entity Type | Organization
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Legal Business Name | PELVIC HEALTH PT BY PHOENIX LLC
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 12627 E CENTRAL AVE STE 308
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City | WICHITA
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State | KS
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Zip | 67206-2839
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Country | US
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Telephone | 316-260-3311
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Fax | 316-260-6696
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Provider Business Mailing Address
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Address Line | 12627 E CENTRAL AVE STE 308
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City | WICHITA
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State | KS
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Zip | 67206-2839
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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 | DIRECTOR OF BUSINESS OPERATIONS
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Name | LOGAN MADDING
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Credential |
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Telephone | 316-260-3311
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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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