Provider Demographics
NPI:1710097043
Name:ABILENE PHYSICAL THERAPY AND SPORTS REHAB PA
Entity Type:Organization
Organization Name:ABILENE PHYSICAL THERAPY AND SPORTS REHAB PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FROELICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-263-3646
Mailing Address - Street 1:103 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-1547
Mailing Address - Country:US
Mailing Address - Phone:785-263-3646
Mailing Address - Fax:785-263-3689
Practice Address - Street 1:103 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-1547
Practice Address - Country:US
Practice Address - Phone:785-263-3646
Practice Address - Fax:785-263-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5642110001Medicare NSC