Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 11-03399 | KS |
Y | 2251P0200X | Physical Therapist - Pediatrics | 2004019501 | MO |
NPI | 1033119359 |
---|---|
Provider Name | Mrs. Angela Marie Hoban |
First Address | Overland Park, KS 66211-2064 |
Second Address | Kansas City, MO 64111-1921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35230016 | BCBS OF KANSAS CITY (01) | MO |