Provider Demographics
NPI:1376862300
Name:ANTLE, DEANA J (PTA)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:J
Last Name:ANTLE
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 1:6405 METCALF AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3931
Mailing Address - Country:US
Mailing Address - Phone:913-831-2721
Mailing Address - Fax:913-384-0127
Practice Address - Street 1:6405 METCALF AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-3931
Practice Address - Country:US
Practice Address - Phone:913-831-2721
Practice Address - Fax:913-384-0127
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115996225200000X
KS14-00216225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant