Provider Demographics
NPI:1518278597
Name:KATZ, MICHAEL SHANE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHANE
Last Name:KATZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:SHANE
Other - Middle Name:
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:2803 N LORRAINE ST
Practice Address - Street 2:STE F
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-4354
Practice Address - Country:US
Practice Address - Phone:620-662-3111
Practice Address - Fax:620-662-3122
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist