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NPI Code Detail

MEDICARE: MR. CASEY SEAN TAJCHMAN RPT

MEDICARE: MR. CASEY SEAN TAJCHMAN RPT
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 Therapist11-02993KS

General Provider Information

NPI Number : 1477833614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CASEY SEAN TAJCHMAN RPT
Provider Business Mailing Address
First Line : 758 N REDBARN LN
Second Line :
City : WICHITA
State : KS
Zip : 67212-3685
Country : US
Telephone Number : 316-962-8046
Fax Number :
Provider Business Practice Location Address
First Line : 551 NORTH HILLSIDE
Second Line :
City : WICHITA
State : KS
Zip : 67214-4976
Country : US
Telephone Number : 316-962-8046
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2011
Last Update Date : 08/19/2011

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