Provider Demographics
NPI:1790569192
Name:PHYSICAL THERAPY BY PHOENIX OF HUTCHINSON LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY BY PHOENIX OF HUTCHINSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-260-3311
Mailing Address - Street 1:3223 N WEBB RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1627 N LORRAINE ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-5656
Practice Address - Country:US
Practice Address - Phone:620-242-1941
Practice Address - Fax:316-260-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy