MEDICARE: NEIL LYNN EHLING PTA

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
1	225200000X	Physical Therapy Assistant	14-02231	KS

General Provider Information

NPI Number	:	1386924959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL LYNN EHLING PTA

Provider Business Mailing Address
First Line	:	200 W DOUGLAS AVE
Second Line	:	STE 1040
City	:	WICHITA
State	:	KS
Zip	:	67202-3013
Country	:	US
Telephone Number	:	316-263-0003
Fax Number	:	316-263-1241

Provider Business Practice Location Address
First Line	:	1125 N MAIN ST
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-4405
Country	:	US
Telephone Number	:	620-662-3111
Fax Number	:	620-662-3122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2011
Last Update Date	:	08/26/2011

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