MEDICARE: WESTERN KANSAS REHABILITATION SERVICES PA

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1962746826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN KANSAS REHABILITATION SERVICES PA

Provider Business Mailing Address
First Line	:	1501 E FULTON TER
Second Line	:	STE 1
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-6289
Country	:	US
Telephone Number	:	620-805-6883
Fax Number	:	620-805-6886

Provider Business Practice Location Address
First Line	:	1501 E FULTON TER
Second Line	:	STE 1
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-6289
Country	:	US
Telephone Number	:	620-805-6883
Fax Number	:	620-805-6886

Authorized Official
Title or Position	:	PARTNER
Name	:	CHARLES LEE WILLIAMS
Credential	:	MSPT
Telephone Number	:	620-640-4058

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	01/13/2013

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