Provider Demographics
NPI:1518430909
Name:GIVENS, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GIVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:KS
Mailing Address - Zip Code:67669-1630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:ELLIS
Practice Address - State:KS
Practice Address - Zip Code:67637-1757
Practice Address - Country:US
Practice Address - Phone:785-269-7287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant