Provider Demographics
NPI:1366417768
Name:NOTARIO, NICHOLAS R (RPT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:R
Last Name:NOTARIO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N CARRIAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4506
Mailing Address - Country:US
Mailing Address - Phone:316-612-4900
Mailing Address - Fax:316-612-4999
Practice Address - Street 1:545 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4506
Practice Address - Country:US
Practice Address - Phone:316-612-4900
Practice Address - Fax:316-612-4999
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist