Healthcare Provider Details

I. General information

NPI: 1598916751
Provider Name (Legal Business Name): CARMINE J. CAGLE P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 ANTIOCH RD SUITE 430
MERRIAM KS
66204-1258
US

IV. Provider business mailing address

15000 S OUTER BELT RD
LONE JACK MO
64070-9519
US

V. Phone/Fax

Practice location:
  • Phone: 888-652-9225
  • Fax: 913-652-9198
Mailing address:
  • Phone: 816-697-3858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number117089
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: