Provider Demographics
NPI:1972657823
Name:HUSLIG, THERESA M (PT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:HUSLIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67220-1746
Mailing Address - Country:US
Mailing Address - Phone:316-744-2169
Mailing Address - Fax:
Practice Address - Street 1:1131 S CLIFTON AVE STE C
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2912
Practice Address - Country:US
Practice Address - Phone:316-689-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist