Provider Demographics
NPI:1942782131
Name:PHILLIPS, ABBIE (PTA)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:
Last Name:PHILLIPS
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 1:8061 N DENVER AVE APT 2306
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-1059
Mailing Address - Country:US
Mailing Address - Phone:816-536-3648
Mailing Address - Fax:
Practice Address - Street 1:4301 MADISON AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3491
Practice Address - Country:US
Practice Address - Phone:816-931-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant