Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 11-02091 | KS |
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1023013463 |
---|---|
Provider Name | Mr. Jay Franz |
First Address | Wichita, KS 67209-3902 |
Second Address | Wichita, KS 67226-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140388 | BLUE CROSS (01) |