Provider Demographics
NPI:1164204343
Name:RATCLIFF, JOANNA K (PTA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:K
Last Name:RATCLIFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:JOANNA
Other - Middle Name:K
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17107 E 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64056-1613
Mailing Address - Country:US
Mailing Address - Phone:816-456-0354
Mailing Address - Fax:
Practice Address - Street 1:17107 E 1ST ST N
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056-1613
Practice Address - Country:US
Practice Address - Phone:816-456-0354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023001746225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant