Provider Demographics
NPI:1124556709
Name:BRIGHAM PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BRIGHAM PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:316-866-7067
Mailing Address - Street 1:PO BOX 75345
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67275-0345
Mailing Address - Country:US
Mailing Address - Phone:316-259-2407
Mailing Address - Fax:
Practice Address - Street 1:7335 W 33RD ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-9368
Practice Address - Country:US
Practice Address - Phone:316-866-7067
Practice Address - Fax:844-788-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1104875261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy