Provider Demographics
NPI:1396200663
Name:VALERIE C WONDRA
Entity Type:Organization
Organization Name:VALERIE C WONDRA
Other - Org Name:MOVE2PLAY PEDIATRIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:316-655-3403
Mailing Address - Street 1:301 S MERIDIAN AVE RM 113
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2629
Mailing Address - Country:US
Mailing Address - Phone:316-655-3403
Mailing Address - Fax:316-247-8191
Practice Address - Street 1:9229 E 37TH ST N STE 201
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2003
Practice Address - Country:US
Practice Address - Phone:316-655-3403
Practice Address - Fax:316-247-8191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment