Provider Demographics
NPI:1255466421
Name:HEARTLAND PHYSICAL THERAPY & REHABILITATION, LLC
Entity Type:Organization
Organization Name:HEARTLAND PHYSICAL THERAPY & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:785-456-8699
Mailing Address - Street 1:1411 W US HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1256
Mailing Address - Country:US
Mailing Address - Phone:785-456-8699
Mailing Address - Fax:
Practice Address - Street 1:1411 W US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1256
Practice Address - Country:US
Practice Address - Phone:785-456-8699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1102547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS115655Medicare ID - Type Unspecified