Individual
MARK SUDBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 UTAH ST, HIAWATHA, KS 66434-2326
(785) 742-2131
Mailing address
201 S 4TH ST, HIAWATHA, KS 66434-2402
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-04693
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016289165
PTAN
KS
05
—
30004682200001
—
KS
05
—
480157252
—
MO
Enumeration date
03/18/2015
Last updated
03/27/2026
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