Provider Demographics
NPI:1609472000
Name:LOWE, TREVOR BENJAMIN (PTA)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:BENJAMIN
Last Name:LOWE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 HEIZER ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-2635
Mailing Address - Country:US
Mailing Address - Phone:785-302-0111
Mailing Address - Fax:
Practice Address - Street 1:1156 K-14
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:KS
Practice Address - Zip Code:67439
Practice Address - Country:US
Practice Address - Phone:785-472-3167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03544225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant