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NPI Code Detail

MEDICARE: CAROL E BREHM PTA

MEDICARE: CAROL E BREHM PTA
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
1225200000XPhysical Therapy AssistantKS

General Provider Information

NPI Number : 1639335425
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL E BREHM PTA
Provider Business Mailing Address
First Line : 200 W DOUGLAS AVE
Second Line : SUITE 1040
City : WICHITA
State : KS
Zip : 67202-3013
Country : US
Telephone Number : 316-263-0003
Fax Number :
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 :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2008
Last Update Date : 01/31/2012

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Directions to “ CAROL E BREHM PTA” Practice Location

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