Basic Information
| Provider Information | |||||||||
| NPI: | 1801122254 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | URBANEK | ||||||||
| FirstName: | CONNIE | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 N PARKRIDGE CT | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672052006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167732967 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5005 E 21ST ST N | ||||||||
| Address2: | COLLEGE HILL NURSING AND REHAB CENTER | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166859291 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2009 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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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 | 225200000X | 14-01126 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.