Individual
MS. CORRIE LYNN GRAVES TICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2727 TRACY AVE, KANSAS CITY, MO 64109-1243
(816) 889-3502
Mailing address
201 NE 83RD TER, KANSAS CITY, MO 64118-1253
(816) 420-9901
(816) 420-9901
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
20000152219
MO
Other
Enumeration date
08/16/2010
Last updated
08/16/2010
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