Unknown Individual – Physical Therapist, NPI 1164504627

Unknown Individual is a healthcare provider. based in Andover, Kansas. specializing in Physical Therapist. They hold a License No. 01999 (KS). The NPI Number for Unknown Individual is 1164504627

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164504627
Phone
(316) 733-5095
Address
1423 ELM ST
Deactivation Date
13 October 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3166512380
Graduation Year
1993 (33 years ago)
PAC ID
1153425384
Group Practice PAC ID
2062433956
Professional Enrollment ID
I20070328000544
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1423, Elm Street, Andover, Butler County, Kansas, 67002, United States

    ANDOVER, KS 670029033

    Phone: (316) 733-5095

    Type: Mailing

  • 2682, North Webb Road, Minneha, Wichita, Sedgwick County, Kansas, 67226, United States

    WICHITA, KS 672268110

    Phone: (316) 771-4049

    Fax: (316) 858-1911

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes6117$0
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Insurance plans in this area (ZIP 67002)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2062433956View full group profile
NameSpecialtyState
Occupational Therapist In Private PracticeKS
Qualified AudiologistKS
Physical Therapist In Private PracticeKS
Physical Therapist In Private PracticeKS
-KS
-KS
-KS
Physical Therapist In Private PracticeKS
-KS
-KS

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1164504627 is assigned to Unknown Individual under the national enumeration system.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
What kind of provider is Unknown Individual?
The page reflects Physical Therapist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Andover, Kansas because that is what the record indicates for Unknown Individual.
What if Andover, Kansas seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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