Provider Demographics
NPI:1306133772
Name:CAIN, ANGIE MARIE (PT)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:MARIE
Last Name:CAIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:MARIE
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10351 BARKLEY
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212
Mailing Address - Country:US
Mailing Address - Phone:417-840-2847
Mailing Address - Fax:
Practice Address - Street 1:10351 BARKLEY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212
Practice Address - Country:US
Practice Address - Phone:417-840-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020651225100000X
KS11-04368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist