Provider Demographics
NPI:1063108389
Name:NETHERCOT, ADRIAN (PTA)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:NETHERCOT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WINDWARD DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-5420
Mailing Address - Country:US
Mailing Address - Phone:316-204-8567
Mailing Address - Fax:
Practice Address - Street 1:200 WILLOW RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:KS
Practice Address - Zip Code:67063-1939
Practice Address - Country:US
Practice Address - Phone:620-947-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03878225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant