Provider Demographics
NPI:1316013204
Name:INTERACTIVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:INTERACTIVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:785-246-2300
Mailing Address - Street 1:3405 NW HUNTERS RIDGE TER STE 300
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618-2510
Mailing Address - Country:US
Mailing Address - Phone:785-246-2300
Mailing Address - Fax:785-246-2301
Practice Address - Street 1:4745 NW HUNTERS RIDGE CIR STE D
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2538
Practice Address - Country:US
Practice Address - Phone:785-246-2300
Practice Address - Fax:785-246-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02038261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS115585OtherBCBS GROUP NUMBER
KS100447490AMedicaid
KS115585OtherBCBS GROUP NUMBER
KSDA1053Medicare PIN