1912999590 NPI number — PHYSICAL THERAPY PLUS PA

Table of content: (NPI 1912999590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912999590 NPI number — PHYSICAL THERAPY PLUS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY PLUS PA
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:
Provider Other Organization Name Type Code:
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:
1912999590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 ELMHURST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401-7404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-825-2911
Provider Business Mailing Address Fax Number:
785-825-2912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 ELMHURST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401-7404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-825-2911
Provider Business Practice Location Address Fax Number:
785-825-2912
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRYE
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHYSICAL THERAPIST OWNER
Authorized Official Telephone Number:
785-825-2911

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1100700 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 1102391 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 115669 . This is a "BC BS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com