Individual
ETHAN JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9425 MISSION RD, LEAWOOD, KS 66206-2045
(913) 381-2100
Mailing address
200 W DOUGLAS AVE STE 250, WICHITA, KS 67202-3002
(316) 263-0003
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-03380
KS
Other
Enumeration date
08/23/2022
Last updated
08/23/2022
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