Provider Demographics
NPI:1851939425
Name:WICHITA INJURY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WICHITA INJURY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLU
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUNSANMI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:316-260-2424
Mailing Address - Street 1:6127 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4209
Mailing Address - Country:US
Mailing Address - Phone:316-260-2424
Mailing Address - Fax:
Practice Address - Street 1:9449 E 21ST ST N STE 200
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2970
Practice Address - Country:US
Practice Address - Phone:316-260-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-14
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200298830AMedicaid