NPIMap

Organization Active NPI

Kansas Fitness Physio, PA

  • Physical Therapist
  • Leavenworth, KS
National Provider Identifier
1497854822
Registry record updated Sep 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11-01721 Issued in KS
Legal business name
KANSAS FITNESS PHYSIO, PA
Practice address
2916 S 4TH St Ste 200
Leavenworth, KS 66048-5016
Phone
(913) 225-9340
Fax
(913) 273-8484
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marc Douek, PTNPI 1396922274
Title
Ceo
Phone
(919) 327-7697

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 11-01721 KS Primary

Addresses

Primary practice location

2916 S 4TH St Ste 200
Leavenworth, KS 66048-5016

Mailing address

6100 E Central Ave
Wichita, KS 67208-4244
Phone (855) 749-7461

Other practice location 1

17800 W 106th St Ste A
Olathe, KS 66061-2882
Phone (913) 225-9340

Other identifiers 10

IdentifierTypeStateIssuer
014746OtherKSBCBSKS
370818800OtherKSOWCP
1310946OtherKSUHMIDWEST
22141014OtherKSBCBSKC
4625725OtherKSAETNA PPO
22141014OtherKSPHP
0178177OtherDEPARTMENT OF LABOR WASH
2265205OtherKSAETNA HMO
6290661OtherKSCIGNA PPO
370818800OtherOWCOP PROVIDER NUMBER

Other names 2

  • Mowrey Rehab Consultants, PA Former legal business name
  • Professional Rehabilitation Specialists, P.A. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050207000506 KS Part B Supplier - Clinic/Group Practice 0749231868 Receives reassigned benefits from 5 practitioners
Practice locations: Leavenworth, KS; Olathe, KS

National Provider Directory

National Provider Directory
Tax ID family
Kansas Fitness Physio PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2916 S 4th St
Ste 200
Leavenworth, KS 66048
Phone (913) 225-9340

17800 W 106th St
Ste A
Olathe, KS 66061
Phone (913) 225-9340

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788307200000",
    "number": "1497854822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 E CENTRAL AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672084244",
            "telephone_number": "855-749-7461",
            "fax_number": "913-273-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2916 S 4TH ST STE 200",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "660485016",
            "telephone_number": "913-225-9340",
            "fax_number": "913-273-8484"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17800 W 106th St Ste A",
            "address_purpose": "LOCATION",
            "city": "Olathe",
            "state": "KS",
            "postal_code": "660612882",
            "country_code": "US",
            "telephone_number": "913-225-9340",
            "fax_number": "913-271-8484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KANSAS FITNESS PHYSIO, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A",
        "authorized_official_last_name": "DOUEK",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-327-7697",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-01721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSKS",
            "identifier": "014746",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "370818800",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHMIDWEST",
            "identifier": "1310946",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSKC",
            "identifier": "22141014",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "4625725",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "22141014",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR WASH",
            "identifier": "0178177",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "2265205",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PPO",
            "identifier": "6290661",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCOP PROVIDER NUMBER",
            "identifier": "370818800",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mowrey Rehab Consultants, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Professional Rehabilitation Specialists, P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Professional Rehabilitation Specialists, P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Leavenworth, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.