Provider Demographics
NPI:1609857366
Name:FIRST STREET REHAB INC
Entity Type:Organization
Organization Name:FIRST STREET REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:HUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:620-549-3757
Mailing Address - Street 1:607 E 1ST AVE
Mailing Address - Street 2:PO BOX 14
Mailing Address - City:ST JOHN
Mailing Address - State:KS
Mailing Address - Zip Code:67576-2223
Mailing Address - Country:US
Mailing Address - Phone:620-549-3757
Mailing Address - Fax:
Practice Address - Street 1:607 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:ST JOHN
Practice Address - State:KS
Practice Address - Zip Code:67576-2223
Practice Address - Country:US
Practice Address - Phone:620-549-3757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00777225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS115681Medicare ID - Type UnspecifiedPROVIDER NUMBER