Provider Demographics
NPI:1003190513
Name:PHYSIOTHERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:FLECK
Authorized Official - Last Name:POOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-467-8705
Mailing Address - Street 1:2300 COIT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3768
Mailing Address - Country:US
Mailing Address - Phone:469-467-8705
Mailing Address - Fax:267-321-2550
Practice Address - Street 1:6505 E 37TH ST N
Practice Address - Street 2:SUITE 700
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-3232
Practice Address - Country:US
Practice Address - Phone:316-854-5857
Practice Address - Fax:316-854-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2463Medicare PIN