Healthcare Provider Details

I. General information

NPI: 1457248213
Provider Name (Legal Business Name): SKYE LIANE EDUARTE CORONEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SKYE CORONEL

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 MAIN ST STE 202
KANSAS CITY MO
64111-1946
US

IV. Provider business mailing address

11917 W 109TH ST APT 209
OVERLAND PARK KS
66210-3981
US

V. Phone/Fax

Practice location:
  • Phone: 816-472-1800
  • Fax:
Mailing address:
  • Phone: 214-259-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-07933
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: