Provider Demographics
NPI:1427084334
Name:MANSON, REBECCA S (PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:MANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 N AMIDON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2121
Mailing Address - Country:US
Mailing Address - Phone:316-262-8800
Mailing Address - Fax:620-708-4022
Practice Address - Street 1:1999 N AMIDON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2121
Practice Address - Country:US
Practice Address - Phone:316-262-8800
Practice Address - Fax:620-708-4022
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100322790 AMedicaid
059756Medicare ID - Type Unspecified
KS100322790 AMedicaid