Provider Demographics
NPI:1235243460
Name:SALT CREEK REHAB LLC
Entity Type:Organization
Organization Name:SALT CREEK REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWINDALE
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:785-528-1123
Mailing Address - Street 1:104 W MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSAGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66523
Mailing Address - Country:US
Mailing Address - Phone:785-528-1123
Mailing Address - Fax:
Practice Address - Street 1:104 W MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:OSAGE CITY
Practice Address - State:KS
Practice Address - Zip Code:66523
Practice Address - Country:US
Practice Address - Phone:785-528-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00751225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty