Organization
ADVANCED THERAPY & SPORTS MED., LLC
Active
Organization
ADVANCED THERAPY & SPORTS MED., LLC
Active
Other names
Advanced Therapy & Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
KEVYN SOUPISET PT (OWNER)
(620) 792-7868
Entity
Organization
Contact information
Practice address
4801 10TH ST, GREAT BEND, KS 67530-3252
(620) 792-7868
(620) 792-7867
Mailing address
4801 10TH ST, GREAT BEND, KS 67530-3252
(620) 792-7868
(620) 792-7867
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
04/10/2019
Last updated
01/26/2023
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