Provider Demographics
NPI:1225069602
Name:SMITH, LANA K (PT)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 E 37TH ST N
Mailing Address - Street 2:STE 700
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-3232
Mailing Address - Country:US
Mailing Address - Phone:316-854-5857
Mailing Address - Fax:316-854-5858
Practice Address - Street 1:6505 E 37TH ST N
Practice Address - Street 2:STE 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS141241OtherMEDICARE
KS200307070AMedicaid
KS200307070AMedicaid
KSKA2463Medicare PIN