Provider Demographics
NPI:1841020823
Name:GRABAST, CULLEN EDWIN (DPT)
Entity type:Individual
Prefix:
First Name:CULLEN
Middle Name:EDWIN
Last Name:GRABAST
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22378 S HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-3148
Mailing Address - Country:US
Mailing Address - Phone:913-592-9101
Mailing Address - Fax:913-392-7122
Practice Address - Street 1:22378 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-3148
Practice Address - Country:US
Practice Address - Phone:913-592-9101
Practice Address - Fax:913-392-7122
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist