Basic Information
| Provider Information | |||||||||
| NPI: | 1770639221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TREBILCOCK | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9110 E WINDWOOD CT | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672261511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166342668 | ||||||||
| FaxNumber: | 3166343482 | ||||||||
| Practice Location | |||||||||
| Address1: | 1151 N ROCK RD | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672061262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166343520 | ||||||||
| FaxNumber: | 3166343482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11-01494 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.