Provider Demographics
NPI:1912416041
Name:IN CONTROL PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:IN CONTROL PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:620-218-5193
Mailing Address - Street 1:308 S BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1306
Mailing Address - Country:US
Mailing Address - Phone:620-218-5193
Mailing Address - Fax:316-691-8866
Practice Address - Street 1:5002 E CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4167
Practice Address - Country:US
Practice Address - Phone:316-691-8885
Practice Address - Fax:316-691-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20109034Medicaid