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NPI Code Detail

MEDICARE: ANNETTE STUCKY RPT

MEDICARE: ANNETTE STUCKY 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 Therapist11-01068KS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00385864OTHERKSRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487629887
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNETTE STUCKY RPT
Provider Business Mailing Address
First Line : 200 W DOUGLAS
Second Line : STE 1040
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 : 2311 S KANSAS RD
Second Line :
City : NEWTON
State : KS
Zip : 67114-9032
Country : US
Telephone Number : 316-283-7187
Fax Number : 316-283-7189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 02/17/2009

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