Provider Demographics
NPI:1487629887
Name:STUCKY, ANNETTE (RPT)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:STUCKY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:2311 S KANSAS RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9032
Practice Address - Country:US
Practice Address - Phone:316-283-7187
Practice Address - Fax:316-283-7189
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00385864OtherRAILROAD MEDICARE
KS200270060BMedicaid
KS200270060DMedicaid
KSP00385864OtherRAILROAD MEDICARE
KS141124Medicare PIN