Provider Demographics
NPI:1699979088
Name:WRENCH, THEODORE DAVID (MPT)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:DAVID
Last Name:WRENCH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:MR
Other - First Name:TAD
Other - Middle Name:D
Other - Last Name:WRENCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:315 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:KS
Practice Address - Zip Code:67579-1615
Practice Address - Country:US
Practice Address - Phone:620-204-6116
Practice Address - Fax:620-204-6117
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist