Organization
ADVANCED THERAPY & SPORTS MEDICINE, CHARTERED
Active
Other names
Advanced Therapy & Sports Medicine,Chartered
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA MALONE PT (PRESIDENT)
(620) 792-7868
Entity
Organization
Contact information
Practice address
4801 10TH ST, GREAT BEND, KS 67530-3252
(620) 792-7868
Mailing address
4801 10TH ST, GREAT BEND, KS 67530-3542
(620) 792-7868
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
261QP2000X
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200508610A
—
KS
Enumeration date
07/06/2006
Last updated
03/09/2017
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