MEDICARE: ALICIA MASENTHIN

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	208100000X	Physical Medicine & Rehabilitation Physician	11-05090	KS
2	225100000X	Physical Therapist	11-05090	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11-05090	OTHER	KS	PT LICENSE

General Provider Information

NPI Number	:	1952753386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA MASENTHIN

Provider Business Mailing Address
First Line	:	4850 S SENECA ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67217-4826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 S ELIZABETH ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67213-3403
Country	:	US
Telephone Number	:	316-262-4473
Fax Number	:

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	12/17/2018

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Directions to “ ALICIA MASENTHIN ” Practice Location

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