Organization
THERACARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE L MOCK (PRACTICE MANAGER)
(316) 945-8020
Entity
Organization
Contact information
Practice address
3729 W CENTRAL AVE, WICHITA, KS 67203-4925
(316) 945-8020
(316) 616-0106
Mailing address
3729 W CENTRAL AVE, WICHITA, KS 67203-4925
(316) 945-8020
(316) 616-0106
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115543
BCBS PROVIDER NUMBER
KS
01
—
465890
FAMILY HEALTH PARTNERS
KS
Enumeration date
03/08/2007
Last updated
08/22/2020
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