Provider Demographics
NPI:1891758116
Name:PRUSA, ANTHONY A (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:PRUSA
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 1:118 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2518
Mailing Address - Country:US
Mailing Address - Phone:620-356-3333
Mailing Address - Fax:620-356-3338
Practice Address - Street 1:118 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2518
Practice Address - Country:US
Practice Address - Phone:620-356-3333
Practice Address - Fax:620-356-3338
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140589Medicare ID - Type Unspecified
KSS21818Medicare UPIN