Provider Demographics
NPI:1487287082
Name:PHOENIX PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PHOENIX PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THERAPY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARNDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-967-9820
Mailing Address - Street 1:12627 E CENTRAL AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12627 E CENTRAL AVE STE 308
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2839
Practice Address - Country:US
Practice Address - Phone:316-260-3311
Practice Address - Fax:316-260-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy