Provider Demographics
NPI:1336655356
Name:MIES, CHARLENE ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ANN
Last Name:MIES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:ANN
Other - Last Name:SANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10940 PARALLEL PKWY STE I
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4515
Mailing Address - Country:US
Mailing Address - Phone:913-378-0778
Mailing Address - Fax:913-378-0782
Practice Address - Street 1:10940 PARALLEL PKWY STE I
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4515
Practice Address - Country:US
Practice Address - Phone:913-378-0778
Practice Address - Fax:913-378-0782
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist