Provider Demographics
NPI:1548791148
Name:VENTEICHER, SHANE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:VENTEICHER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-1648
Mailing Address - Country:US
Mailing Address - Phone:712-292-9135
Mailing Address - Fax:
Practice Address - Street 1:1801 N COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-1648
Practice Address - Country:US
Practice Address - Phone:712-292-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-011622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer