1134398803 NPI number — LIUDAHL BACHMAN & HOOVER, INC

Table of content: (NPI 1134398803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134398803 NPI number — LIUDAHL BACHMAN & HOOVER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIUDAHL BACHMAN & HOOVER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GARDNER PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134398803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDNER
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66030-1251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-884-6755
Provider Business Mailing Address Fax Number:
913-884-6756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDNER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66030-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-884-6755
Provider Business Practice Location Address Fax Number:
913-884-6756
Provider Enumeration Date:
02/26/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIUDAHL
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
913-884-6755

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  11-02829 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)