Healthcare Provider Details

I. General information

NPI: 1790902864
Provider Name (Legal Business Name): ANGELA LEE BARNES PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 ANTIOCH ROAD STE430
MERRIAM KS
66204
US

IV. Provider business mailing address

2413 BIG PINE TER
SAINT JOSEPH MO
64503-3116
US

V. Phone/Fax

Practice location:
  • Phone: 913-652-9229
  • Fax: 913-652-9198
Mailing address:
  • Phone: 816-671-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2004002763
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1867
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: