Provider Demographics
NPI:1942615976
Name:LONGHOFER, MICHAEL RAY (ATC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:LONGHOFER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-6000
Mailing Address - Fax:
Practice Address - Street 1:2660 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2442
Practice Address - Country:US
Practice Address - Phone:785-270-8880
Practice Address - Fax:785-270-8881
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-28
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-000152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer