Provider Demographics
NPI:1780177543
Name:THACH, KAILEY P (DPT)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:P
Last Name:THACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 N LORRAINE ST STE F
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4355
Mailing Address - Country:US
Mailing Address - Phone:620-662-3111
Mailing Address - Fax:620-662-3122
Practice Address - Street 1:2803 N LORRAINE ST STE F
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-4355
Practice Address - Country:US
Practice Address - Phone:620-662-3111
Practice Address - Fax:620-662-3122
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist