Provider Demographics
NPI:1336496157
Name:QUANTUM SHIFT PHYSICAL THERAPY AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:QUANTUM SHIFT PHYSICAL THERAPY AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST AND OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:785-727-3603
Mailing Address - Street 1:1201 WAKARUSA DR STE E1
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1892
Mailing Address - Country:US
Mailing Address - Phone:785-856-7389
Mailing Address - Fax:785-856-7392
Practice Address - Street 1:1201 WAKARUSA DR STE E1
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-1892
Practice Address - Country:US
Practice Address - Phone:785-856-7389
Practice Address - Fax:785-856-7392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02207261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy