Provider Demographics
NPI:1346381316
Name:MCBRIDE, CELESTE ANN (PTA)
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:ANN
Last Name:MCBRIDE
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 1:1145 SW SUNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3789
Mailing Address - Country:US
Mailing Address - Phone:816-554-3535
Mailing Address - Fax:
Practice Address - Street 1:10560 BARKLEY ST
Practice Address - Street 2:SUITE 330
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1811
Practice Address - Country:US
Practice Address - Phone:913-652-9229
Practice Address - Fax:913-652-9198
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115025225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant