Basic Information
| Provider Information | |||||||||
| NPI: | 1699308882 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL THERAPY AT FHO LLC | ||||||||
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| Address1: | 700 W CENTRAL AVE STE 206 | ||||||||
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| City: | EL DORADO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670422186 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 700 W CENTRAL AVE STE 206 | ||||||||
| Address2: | |||||||||
| City: | EL DORADO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670422186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3169901699 | ||||||||
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| ProviderEnumerationDate: | 02/17/2020 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | LIBRODO | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8473934505 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.