Provider Demographics
NPI:1730135302
Name:TRANQUILLITY PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:TRANQUILLITY PHYSICAL THERAPY INC
Other - Org Name:TRANQUILLITY PHYSICAL AND MASSAGE THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:QASSAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-773-0909
Mailing Address - Street 1:940 N TYLER RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3265
Mailing Address - Country:US
Mailing Address - Phone:316-773-0909
Mailing Address - Fax:316-773-0606
Practice Address - Street 1:940 N TYLER RD
Practice Address - Street 2:STE. 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3265
Practice Address - Country:US
Practice Address - Phone:316-773-0909
Practice Address - Fax:316-773-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS115696OtherBLUE CROSS BLUE SHIELD
KS200298740AMedicaid
KS115584Medicare ID - Type Unspecified
KS115696Medicare PIN