Provider Demographics
NPI:1659817476
Name:PREMIER REHAB SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:PREMIER REHAB SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:620-306-0031
Mailing Address - Street 1:1517 CR 1200
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:KS
Mailing Address - Zip Code:67333-2839
Mailing Address - Country:US
Mailing Address - Phone:620-306-0031
Mailing Address - Fax:
Practice Address - Street 1:1517 CR 1200
Practice Address - Street 2:
Practice Address - City:CANEY
Practice Address - State:KS
Practice Address - Zip Code:67333-2839
Practice Address - Country:US
Practice Address - Phone:620-306-0031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03029261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy