Provider Demographics
NPI:1629292743
Name:GARNETT, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:GARNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:HALSTEAD
Mailing Address - State:KS
Mailing Address - Zip Code:67056-2129
Mailing Address - Country:US
Mailing Address - Phone:316-835-3131
Mailing Address - Fax:
Practice Address - Street 1:915 MCNAIR ST
Practice Address - Street 2:
Practice Address - City:HALSTEAD
Practice Address - State:KS
Practice Address - Zip Code:67056-2518
Practice Address - Country:US
Practice Address - Phone:316-835-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00139225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant