Provider Demographics
NPI:1669181137
Name:IRON HORSE SALON AND THERAPY LLC
Entity type:Organization
Organization Name:IRON HORSE SALON AND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:VERMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:316-217-1492
Mailing Address - Street 1:1159 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:KS
Mailing Address - Zip Code:67428-8843
Mailing Address - Country:US
Mailing Address - Phone:316-217-1492
Mailing Address - Fax:
Practice Address - Street 1:100 S. CHRISTIAN AVE
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107
Practice Address - Country:US
Practice Address - Phone:316-217-1492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy