Provider Demographics
NPI:1689028730
Name:WASHBURN UNIVERSITY OF TOPEKA
Entity Type:Organization
Organization Name:WASHBURN UNIVERSITY OF TOPEKA
Other - Org Name:WASHBURN UNIVERSITY OF TOPEKA SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD ATHLETIC TRAINER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:MS LAT
Authorized Official - Phone:785-670-2119
Mailing Address - Street 1:1700 SW COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66621-0001
Mailing Address - Country:US
Mailing Address - Phone:785-670-2119
Mailing Address - Fax:785-670-1091
Practice Address - Street 1:1700 SW COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66621-0001
Practice Address - Country:US
Practice Address - Phone:785-670-2119
Practice Address - Fax:785-670-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0437194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty