Provider Demographics
NPI:1003202045
Name:VOLGAMORE, REESA (PTA)
Entity Type:Individual
Prefix:
First Name:REESA
Middle Name:
Last Name:VOLGAMORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-8498
Mailing Address - Country:US
Mailing Address - Phone:316-733-1349
Mailing Address - Fax:316-733-0919
Practice Address - Street 1:621 W 21ST ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-8498
Practice Address - Country:US
Practice Address - Phone:316-733-1349
Practice Address - Fax:316-733-0919
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02420225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant