Provider Demographics
NPI:1902255250
Name:GEORGE, KAWEIENTE MIKAYLA (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:KAWEIENTE
Middle Name:MIKAYLA
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 NALL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1285
Mailing Address - Country:US
Mailing Address - Phone:913-588-1227
Mailing Address - Fax:
Practice Address - Street 1:8740 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-8705
Practice Address - Country:US
Practice Address - Phone:913-942-5090
Practice Address - Fax:913-942-5095
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043096225100000X
MO2023027946225100000X
COPTL.0014036225100000X
KS11-05439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist