OrganizationInnovative Physical TherapyPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address545 N. Carriage Parkway, Wichita, KS 67208-4506(316) 612-4900PECOS EnrollmentBased on the most recent information from CMS, provider Innovative Physical Therapy does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1346372588Provider TypeOrganizationFull NameInnovative Physical TherapySubpartNoEnumeration Date3/12/2007Last Updated11/2/2010Contact InformationPractice LocationPractice Address545 N. Carriage Parkway, Wichita, KS 67208-4506Phone(316) 612-4900Fax(316) 612-4999Mailing LocationMailing Address545 N. Carriage Parkway, Wichita, KS 67208-4506Phone(316) 612-4900Fax(316) 612-4999Authorized OfficialNameGohari, Farah M (Owner, Physical Therapist)Phone(316) 612-4900Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense1102277KansasCode225100000XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense1103492KansasProvider IdentifiersIDDescriptionIssuerID100336410BDescriptionMedicaidIssuerUnlistedKansas