Provider Demographics
NPI:1689794661
Name:SOUTHWIND PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:SOUTHWIND PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:785-825-2323
Mailing Address - Street 1:631 E. CRAWFORD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5116
Mailing Address - Country:US
Mailing Address - Phone:785-825-2323
Mailing Address - Fax:785-825-2325
Practice Address - Street 1:631 E. CRAWFORD ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5116
Practice Address - Country:US
Practice Address - Phone:785-825-2323
Practice Address - Fax:785-825-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1102123225100000X
KS1103295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDA 3438OtherRAILROAD MEDICARE
KS115591OtherKANSAS BCBS
KS115591OtherKANSAS BCBS
KSDA 3438OtherRAILROAD MEDICARE