Provider Demographics
NPI:1689200602
Name:PERSONS, PAMELA KAYE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAYE
Last Name:PERSONS
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 1:8189 SW PARALLEL ST
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:KS
Mailing Address - Zip Code:67144-9318
Mailing Address - Country:US
Mailing Address - Phone:316-541-2444
Mailing Address - Fax:
Practice Address - Street 1:1655 S GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-4140
Practice Address - Country:US
Practice Address - Phone:316-685-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-011342251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics