Provider Demographics
NPI:1962746826
Name:WESTERN KANSAS REHABILITATION SERVICES PA
Entity type:Organization
Organization Name:WESTERN KANSAS REHABILITATION SERVICES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:620-640-4058
Mailing Address - Street 1:1501 E FULTON TER
Mailing Address - Street 2:STE 1
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6289
Mailing Address - Country:US
Mailing Address - Phone:620-805-6883
Mailing Address - Fax:620-805-6886
Practice Address - Street 1:1501 E FULTON TER
Practice Address - Street 2:STE 1
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6289
Practice Address - Country:US
Practice Address - Phone:620-805-6883
Practice Address - Fax:620-805-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy