Provider Demographics
NPI:1316306772
Name:RORABAUGH, TYAN
Entity type:Individual
Prefix:
First Name:TYAN
Middle Name:
Last Name:RORABAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N ROCKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1023
Mailing Address - Country:US
Mailing Address - Phone:316-209-2231
Mailing Address - Fax:
Practice Address - Street 1:731 N KLEIN CIR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-7011
Practice Address - Country:US
Practice Address - Phone:316-719-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-14
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02758225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant