Provider Demographics
NPI:1356316830
Name:NEEDHAM, H. MARCUS (MPT)
Entity type:Individual
Prefix:
First Name:H.
Middle Name:MARCUS
Last Name:NEEDHAM
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 E 29TH ST N
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2182
Mailing Address - Country:US
Mailing Address - Phone:316-219-8299
Mailing Address - Fax:316-219-5899
Practice Address - Street 1:9300 E 29TH ST N
Practice Address - Street 2:STE 205
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2182
Practice Address - Country:US
Practice Address - Phone:316-219-8299
Practice Address - Fax:316-219-5899
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02111225100000X
KS225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-02111OtherSTATE LISCENCE NUMBER