Western Legacy Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

WESTERN LEGACY PHYSICAL THERAPY, LLC

Practice address

700 West Avenue a
Cimarron, KS 67835

Phone

(620) 855-6060

NPI assigned

Jul 2, 2025

Organization subpart

No

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

Authorized official

Name

Brooke Nicole Fairbank, PT, DPTNPI 1023858453

Title

Physical Therapist, Owner

Phone

(620) 855-6060

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Practitioners 1

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.

• Brooke Fairbank, DPT

  • Physical Therapist
  • Garden City, KS
  • NPI 1023858453
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1751414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753315200000",
    "number": "1790674802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 389",
            "city": "CIMARRON",
            "state": "KS",
            "postal_code": "678350389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WEST AVENUE A",
            "city": "CIMARRON",
            "state": "KS",
            "postal_code": "67835",
            "telephone_number": "620-855-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN LEGACY PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-02",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A",
        "authorized_official_last_name": "FAIRBANK",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, OWNER",
        "authorized_official_telephone_number": "620-855-6060",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Racy's Medical Clinic
• Randall K Cundiff (Racy's Medical Clinic)
• Shepherd of the Plains Foundation (The Shepherd's Center)
• Usd 102 Cimarron-Ensign
• Jaclyn M Vath, NP
• Western Plains Physician Practices, LLC (Western Plains Primary Care)

• Physical Therapy Clinic/Center in Cimarron, KS
• Providers in Cimarron, KS by specialty
• Physical Therapy Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; 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.