Provider Demographics
NPI:1285215293
Name:CATALYST THERAPY AND SPORTS REHAB LLC
Entity Type:Organization
Organization Name:CATALYST THERAPY AND SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC, CSCS
Authorized Official - Phone:620-282-4825
Mailing Address - Street 1:2817 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4809
Mailing Address - Country:US
Mailing Address - Phone:620-282-4825
Mailing Address - Fax:
Practice Address - Street 1:2817 9TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4809
Practice Address - Country:US
Practice Address - Phone:785-639-2483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy