Provider Demographics
NPI:1932678158
Name:TUBBS, VAN
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:
Last Name:TUBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 N ROCK RD STE 213
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1352
Mailing Address - Country:US
Mailing Address - Phone:316-688-5511
Mailing Address - Fax:316-688-1081
Practice Address - Street 1:3450 N ROCK RD STE 213
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1352
Practice Address - Country:US
Practice Address - Phone:316-688-5511
Practice Address - Fax:316-688-1081
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist