Basic Information
| Provider Information | |||||||||
| NPI: | 1558899567 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMSEY | ||||||||
| FirstName: | KOREY | ||||||||
| MiddleName: | DONAVAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1923 N WEBB RD | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162624886 | ||||||||
| FaxNumber: | 3162624887 | ||||||||
| Practice Location | |||||||||
| Address1: | 1923 N WEBB RD | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162624886 | ||||||||
| FaxNumber: | 3162624887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2017 | ||||||||
| LastUpdateDate: | 05/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | T-04726 | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 11-05731 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 14008618 | 01 | KS | CAQH | OTHER |