Organization
EMPORIA MYOFASCIAL CARE3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ANDREW DEJESUS OTR/L (OWNER)
(620) 803-2097
Entity
Organization
Contact information
Practice address
2522 W 15TH AVE, EMPORIA, KS 66801-6102
(620) 803-2097
Mailing address
2522 W 15TH AVE, EMPORIA, KS 66801-6102
(620) 803-2097
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
09/22/2022
Last updated
10/28/2022
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