MEDICARE: THERESA GARNETT

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	14-00139	KS

General Provider Information

NPI Number	:	1629292743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA GARNETT

Provider Business Mailing Address
First Line	:	507 POPLAR ST
Second Line	:
City	:	HALSTEAD
State	:	KS
Zip	:	67056-2129
Country	:	US
Telephone Number	:	316-835-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 MCNAIR ST
Second Line	:
City	:	HALSTEAD
State	:	KS
Zip	:	67056-2518
Country	:	US
Telephone Number	:	316-835-3535
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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Directions to “ THERESA GARNETT ” Practice Location

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