Provider Demographics
NPI:1588805238
Name:STEWART, ANGELA GAYLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:GAYLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:GAYLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:7736 NE 55TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-4106
Mailing Address - Country:US
Mailing Address - Phone:816-645-3272
Mailing Address - Fax:
Practice Address - Street 1:8121 E HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-3186
Practice Address - Country:US
Practice Address - Phone:816-414-5808
Practice Address - Fax:816-414-5810
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007034748225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant