Provider Demographics
NPI:1942546957
Name:MEYER, KEVIN C (PTA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:C
Last Name:MEYER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 E. LINCOLN
Mailing Address - Street 2:BACK TO ACTION CENTER
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3821
Mailing Address - Country:US
Mailing Address - Phone:316-687-1890
Mailing Address - Fax:316-687-1996
Practice Address - Street 1:2535 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3821
Practice Address - Country:US
Practice Address - Phone:316-687-1890
Practice Address - Fax:316-687-1996
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00102225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant