Provider Demographics
NPI:1942540133
Name:WILDCAT PT, LLC
Entity Type:Organization
Organization Name:WILDCAT PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-276-4974
Mailing Address - Street 1:2810 N BARONS PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3767
Mailing Address - Country:US
Mailing Address - Phone:620-276-4974
Mailing Address - Fax:620-272-9852
Practice Address - Street 1:2810 N BARONS PL
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-3767
Practice Address - Country:US
Practice Address - Phone:620-276-4974
Practice Address - Fax:620-272-9852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02619251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health