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NPI Code Detail

MEDICARE: JARVIS KEITH ODGERS DPT

MEDICARE: JARVIS KEITH ODGERS DPT
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 Therapist11-03942KS

General Provider Information

NPI Number : 1396975207
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARVIS KEITH ODGERS DPT
Provider Business Mailing Address
First Line : 12112 W KELLOGG ST
Second Line :
City : WICHITA
State : KS
Zip : 67235-1100
Country : US
Telephone Number : 316-440-1100
Fax Number :
Provider Business Practice Location Address
First Line : 12112 W KELLOGG ST
Second Line :
City : WICHITA
State : KS
Zip : 67235-1100
Country : US
Telephone Number : 316-440-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2009
Last Update Date : 07/27/2009

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Directions to “ JARVIS KEITH ODGERS DPT” Practice Location

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