Provider Demographics
NPI:1790902864
Name:BARNES, ANGELA LEE (PTA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LEE
Last Name:BARNES
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 1:2413 BIG PINE TER
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-3116
Mailing Address - Country:US
Mailing Address - Phone:816-671-0997
Mailing Address - Fax:
Practice Address - Street 1:6700 ANTIOCH ROAD
Practice Address - Street 2:STE430
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204
Practice Address - Country:US
Practice Address - Phone:913-652-9229
Practice Address - Fax:913-652-9198
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004002763225200000X
KS1867225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant