Organization
INNOVATIVE PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FARAH M GOHARI PT (OWNER, PHYSICAL THERAPIST)
(316) 612-4900
Entity
Organization
Contact information
Practice address
545 N. CARRIAGE PARKWAY, WICHITA, KS 67208-4506
(316) 612-4900
(316) 612-4999
Mailing address
545 N. CARRIAGE PARKWAY, WICHITA, KS 67208-4506
(316) 612-4900
(316) 612-4999
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1102277
KS
225100000X
Physical Therapist
1103492
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100336410B
—
KS
Enumeration date
03/12/2007
Last updated
11/02/2010
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