Provider Demographics
NPI:1295903250
Name:FASTTRACK PHYSICAL THERAPY AND SPORTS REHABILITATION
Entity type:Organization
Organization Name:FASTTRACK PHYSICAL THERAPY AND SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATRINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-722-5722
Mailing Address - Street 1:2290 N TYLER RD #300
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67215
Mailing Address - Country:US
Mailing Address - Phone:316-722-5722
Mailing Address - Fax:316-722-5734
Practice Address - Street 1:2290 N TYLER RD #300
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67215
Practice Address - Country:US
Practice Address - Phone:316-722-5722
Practice Address - Fax:316-722-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1102111261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS115651OtherBCBS KS
KS115651Medicare PIN