Provider Demographics
NPI:1497573414
Name:SAS, ANGELA LUCILLE (DPT, MBA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LUCILLE
Last Name:SAS
Suffix:
Gender:F
Credentials:DPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12453 W 105TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2227
Mailing Address - Country:US
Mailing Address - Phone:913-944-1103
Mailing Address - Fax:
Practice Address - Street 1:23351 PRAIRIE STAR PKWY STE A125
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-7303
Practice Address - Country:US
Practice Address - Phone:913-676-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist