Deana J Antle, PTA

Key facts

NPI

1376862300

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

License

115996 (MO)

Practice address

6405 Metcalf Ave
Suite 220
Overland Park, KS 66202-3931

Phone

(913) 831-2721

Fax

(913) 384-0127

NPI assigned

Jun 1, 2010

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arc Rehabilitation Services, LLC Rehabilitation Practitioner · N Kansas City, MO · NPI 1457411894
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 1, 2010.

{
    "created_epoch": "1275350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275350400000",
    "number": "1376862300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6405 METCALF AVE",
            "address_2": "SUITE 220",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662023931",
            "telephone_number": "913-831-2721",
            "fax_number": "913-384-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6405 METCALF AVE",
            "address_2": "SUITE 220",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662023931",
            "telephone_number": "913-831-2721",
            "fax_number": "913-384-0127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTLE",
        "first_name": "DEANA",
        "middle_name": "J",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-01",
        "last_updated": "2010-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "115996",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KS",
            "license": "14-00216",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Overland Park, KS · Physical Therapy Assistant in Kansas