Provider Demographics
NPI:1720255623
Name:MAYS, HOMER KELVEN
Entity Type:Individual
Prefix:MR
First Name:HOMER
Middle Name:KELVEN
Last Name:MAYS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607A GOLDENROD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67117-8038
Mailing Address - Country:US
Mailing Address - Phone:316-804-4411
Mailing Address - Fax:
Practice Address - Street 1:2607A GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:N. NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67117-8170
Practice Address - Country:US
Practice Address - Phone:316-804-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-11
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02930225100000X
OR4166225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist