Cody Glick
Individual provider Active NPI Physical Therapist · Andover, KS
NPI 1083237283 · NPPES record last updated Nov 27, 2023
Key facts
- NPI
- 1083237283
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 11-05087 (KS)
- Practice address
- 1124 W 21St St
Andover, KS 67002-5500 - Phone
- (316) 201-6983
- NPI assigned
- May 21, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Physical Therapy Services at Cypress LLC
Practice addresses (Care Compare)
11120 E 26TH St N
Wichita, KS 67226-4603
Phone (316) 858-1177
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251118003011 | KS | Practitioner - Physical Therapist in Private Practice | 7113418039 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-05087 | KS | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physical Therapy Services at Cypress LLC | Physical Therapist | Current |
Accepting new patients |
Locations
11120 E 26th St N
Ste 1300
Wichita, KS 67226
Phone (316) 858-1177
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11-05087 | KS | Yes |
Addresses
Primary practice location
1124 W 21St St
Andover, KS 67002-5500
Mailing address
10202 E Windemere St
Wichita, KS 67226-3667
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cody.glick@ksmedcenter.com | Kansas Medical Center LLC |
Other providers in Andover, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.