Provider Demographics
NPI:1710262068
Name:PFANNENSTIEL, PATRICK L (PT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:PFANNENSTIEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1916
Mailing Address - Country:US
Mailing Address - Phone:785-354-6116
Mailing Address - Fax:785-354-5166
Practice Address - Street 1:4019 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1916
Practice Address - Country:US
Practice Address - Phone:785-354-6116
Practice Address - Fax:785-354-5166
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002299OtherMEDICARE PTAN
KS201108150AMedicaid