1730135302 NPI number — TRANQUILLITY PHYSICAL THERAPY INC

Table of content: MISS ALYSSA MARIE DEPAOLIS (NPI 1003360728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730135302 NPI number — TRANQUILLITY PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANQUILLITY PHYSICAL THERAPY 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:
Provider Other Organization Name Type Code:
6
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:
1730135302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 N TYLER RD
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67212-3265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-773-0909
Provider Business Mailing Address Fax Number:
316-773-0606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
940 N TYLER RD
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67212-3265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-773-0909
Provider Business Practice Location Address Fax Number:
316-773-0606
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QASSAS
Authorized Official First Name:
LYNDA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
316-773-0909

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , 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)

  • Identifier: 115696 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200298740A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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