Provider Demographics
NPI:1891339719
Name:BROOKFIELD PHYSICAL REHABILITATION, LLC
Entity Type:Organization
Organization Name:BROOKFIELD PHYSICAL REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HLAVACEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-682-6770
Mailing Address - Street 1:200 W DOUGLAS AVE STE 950
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3033
Mailing Address - Country:US
Mailing Address - Phone:316-682-6770
Mailing Address - Fax:
Practice Address - Street 1:205 SAWTOOTH OAK ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7169
Practice Address - Country:US
Practice Address - Phone:501-520-0016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy