MEDICARE: FIRST STREET REHAB INC

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	14-00777	KS

General Provider Information

NPI Number	:	1609857366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STREET REHAB INC

Provider Business Mailing Address
First Line	:	607 E 1ST AVE
Second Line	:	PO BOX 14
City	:	ST JOHN
State	:	KS
Zip	:	67576-2223
Country	:	US
Telephone Number	:	620-549-3757
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 E 1ST AVE
Second Line	:
City	:	ST JOHN
State	:	KS
Zip	:	67576-2223
Country	:	US
Telephone Number	:	620-549-3757
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DWIGHT NEIL HUSTON
Credential	:	PTA
Telephone Number	:	620-549-3757

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	08/22/2020

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Directions to “FIRST STREET REHAB INC ” Practice Location

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