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NPI Code Detail

MEDICARE: AMIE HOLBROOK MPT

MEDICARE: AMIE HOLBROOK MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist61613OR
2225100000XPhysical TherapistPT00007436WA
3225100000XPhysical Therapist11-06688KS

General Provider Information

NPI Number : 1134182603
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMIE HOLBROOK MPT
Provider Business Mailing Address
First Line : 200 W DOUGLAS AVE STE 1040
Second Line :
City : WICHITA
State : KS
Zip : 67202-3017
Country : US
Telephone Number : 316-263-0003
Fax Number : 316-263-1241
Provider Business Practice Location Address
First Line : 1410 N WOODLAWN BLVD STE D
Second Line :
City : DERBY
State : KS
Zip : 67037-2931
Country : US
Telephone Number : 316-202-0996
Fax Number : 316-202-0997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2006
Last Update Date : 06/10/2021

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Directions to “ AMIE HOLBROOK MPT” Practice Location

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