Provider Demographics
NPI:1780259887
Name:HISER, DAMIEN PAUL (DPT)
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:PAUL
Last Name:HISER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:DAMIEN
Other - Middle Name:PAUL
Other - Last Name:HISER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:7633 W ONEIL ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6136
Mailing Address - Country:US
Mailing Address - Phone:316-249-8737
Mailing Address - Fax:
Practice Address - Street 1:7015 E CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1943
Practice Address - Country:US
Practice Address - Phone:316-558-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-055332251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic