Provider Demographics
NPI:1801122254
Name:URBANEK, CONNIE JEAN (CPTA)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:JEAN
Last Name:URBANEK
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2315 N PARKRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-2006
Mailing Address - Country:US
Mailing Address - Phone:316-773-2967
Mailing Address - Fax:
Practice Address - Street 1:5005 E 21ST ST N
Practice Address - Street 2:COLLEGE HILL NURSING AND REHAB CENTER
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208
Practice Address - Country:US
Practice Address - Phone:316-685-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01126225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant