Provider Demographics
NPI:1598916751
Name:CAGLE, CARMINE J (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CARMINE
Middle Name:J
Last Name:CAGLE
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 1:15000 S OUTER BELT RD
Mailing Address - Street 2:
Mailing Address - City:LONE JACK
Mailing Address - State:MO
Mailing Address - Zip Code:64070-9519
Mailing Address - Country:US
Mailing Address - Phone:816-697-3858
Mailing Address - Fax:
Practice Address - Street 1:6700 ANTIOCH RD
Practice Address - Street 2:SUITE 430
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-1258
Practice Address - Country:US
Practice Address - Phone:888-652-9225
Practice Address - Fax:913-652-9198
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117089225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant