Provider Demographics
NPI:1275620007
Name:PETER, KARLA D (PT)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:D
Last Name:PETER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:200 W DOUGLAS
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3017
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:118 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-2718
Practice Address - Country:US
Practice Address - Phone:620-257-1103
Practice Address - Fax:620-257-1104
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS11-02214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140909Medicare PIN