Provider Demographics
NPI:1043307879
Name:TRAN, ANDY C (PT)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:C
Last Name:TRAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 N RIDGE RD
Mailing Address - Street 2:STE 500
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1227
Mailing Address - Country:US
Mailing Address - Phone:316-440-4901
Mailing Address - Fax:316-440-4904
Practice Address - Street 1:200 W DOUGLAS AVE
Practice Address - Street 2:STE 1040
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3013
Practice Address - Country:US
Practice Address - Phone:316-263-0003
Practice Address - Fax:316-263-1241
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS311810056OtherTAX ID