Provider Demographics
NPI:1013914944
Name:BIRD PHYSICAL THERAPY PA
Entity type:Organization
Organization Name:BIRD PHYSICAL THERAPY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:785-331-0106
Mailing Address - Street 1:535 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2342
Mailing Address - Country:US
Mailing Address - Phone:785-331-0106
Mailing Address - Fax:
Practice Address - Street 1:535 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2342
Practice Address - Country:US
Practice Address - Phone:785-331-0106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100316840-BMedicaid
KS115534Medicare ID - Type Unspecified