Provider Demographics
NPI:1538454939
Name:GILE, KASSIE
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:
Last Name:GILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 E SHANNON WOODS CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4105
Mailing Address - Country:US
Mailing Address - Phone:316-681-0824
Mailing Address - Fax:
Practice Address - Street 1:10100 E SHANNON WOODS CIR STE 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4105
Practice Address - Country:US
Practice Address - Phone:316-681-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist