Provider Demographics
NPI:1083678106
Name:DECK, HOWARD CHRISTOPHER (PT)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:CHRISTOPHER
Last Name:DECK
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 1:10014 W HASKELL CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-3006
Mailing Address - Country:US
Mailing Address - Phone:316-448-0553
Mailing Address - Fax:316-221-2528
Practice Address - Street 1:3737 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4925
Practice Address - Country:US
Practice Address - Phone:316-448-0553
Practice Address - Fax:316-221-2528
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1092225100000X
KS11-03608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120241300Medicaid
WY120241300Medicaid