Provider Demographics
NPI:1669651923
Name:CALLICOTT, ANGELA KAY (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:CALLICOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10460 MASTIN ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-5701
Mailing Address - Country:US
Mailing Address - Phone:913-492-7870
Mailing Address - Fax:913-492-3447
Practice Address - Street 1:220 NW RD MIZE RD
Practice Address - Street 2:SUITE B203
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2527
Practice Address - Country:US
Practice Address - Phone:913-220-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1012342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic