Individual
LISA MARIE PENDLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
3729 W CENTRAL AVE, WICHITA, KS 67203-4925
(316) 945-8020
(316) 616-0106
Mailing address
2740 S LINDEN ST, WICHITA, KS 67210-2447
(316) 945-8020
(316) 616-0106
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-03236
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140595
BCBS PROVIDER NUMBER
KS
01
—
6785
PREFERRED HEALTH SYSTEMS
KS
Enumeration date
03/13/2007
Last updated
07/08/2007
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