Healthcare Provider Details

I. General information

NPI: 1497793848
Provider Name (Legal Business Name): GINI ANNE FITE PTA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 KARA CT SUITE 320
LIBERTY MO
64068-1392
US

IV. Provider business mailing address

12814 JAMI CT
KANSAS CITY MO
64166-1234
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-1249
  • Fax:
Mailing address:
  • Phone: 816-351-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-01637
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-00387
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: