Provider Demographics
NPI:1568006617
Name:DORSETT, MARISA GAIL (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:GAIL
Last Name:DORSETT
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 1:15100 METCALF AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2899
Mailing Address - Country:US
Mailing Address - Phone:913-681-7628
Mailing Address - Fax:
Practice Address - Street 1:15100 METCALF AVE STE 102
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2899
Practice Address - Country:US
Practice Address - Phone:913-681-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02989225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant