Provider Demographics
NPI:1699195446
Name:HARTER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:HARTER PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:GABE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:316-550-6132
Mailing Address - Street 1:19931 W. KELLOGG DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-0725
Mailing Address - Country:US
Mailing Address - Phone:316-550-6132
Mailing Address - Fax:316-550-6215
Practice Address - Street 1:19931 W KELLOGG DR
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-8863
Practice Address - Country:US
Practice Address - Phone:785-741-3247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-20
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1104495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty