Provider Demographics
NPI:1588382428
Name:DEGROOT, WILLIAM JUDSON
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JUDSON
Last Name:DEGROOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JUD
Other - Middle Name:
Other - Last Name:DEGROOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:14800 W SAINT TERESA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-9602
Mailing Address - Country:US
Mailing Address - Phone:316-796-7000
Mailing Address - Fax:
Practice Address - Street 1:14800 W SAINT TERESA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-9602
Practice Address - Country:US
Practice Address - Phone:316-796-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant