Provider Demographics
NPI:1548690118
Name:MCCORKLE, ANGELA (RPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MCCORKLE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E BUTTERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3138
Mailing Address - Country:US
Mailing Address - Phone:816-726-3533
Mailing Address - Fax:
Practice Address - Street 1:3965 W 83RD ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5308
Practice Address - Country:US
Practice Address - Phone:913-789-9170
Practice Address - Fax:913-789-9170
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS205092719OtherMINDS MATTER