Provider Demographics
NPI:1720089774
Name:NORTHWEST KANSAS PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:NORTHWEST KANSAS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LARAE
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:785-415-2378
Mailing Address - Street 1:421 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:KS
Mailing Address - Zip Code:67669-1929
Mailing Address - Country:US
Mailing Address - Phone:785-415-2378
Mailing Address - Fax:785-415-2379
Practice Address - Street 1:421 MAIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:KS
Practice Address - Zip Code:67669-1929
Practice Address - Country:US
Practice Address - Phone:785-415-2378
Practice Address - Fax:785-415-2379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLLC NO. 3598190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS115633OtherBLUE CROSS/BLUE SHIELD
KS100319840BMedicaid
KSDC6764OtherRAILROAD MEDICARE
KS590460Other1ST GUARD.
KS590460Other1ST GUARD.