| Doctor Name: | MS. CORRIE LYNN GRAVES TICE |
| NPI Number: | 1295040186 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 20000152219 |
| Business Practice Address: | 2727 Tracy Ave Kansas City, MO - 641091243 |
| Business Phone Number: | 8168893502 |
| Business Fax Number: | |
| Mailing Address: | 201 Ne 83rd Ter, KANSAS CITY |
| State: | MO |
| Postal Code: | 641181253 |
| Phone Number: | 8164209901 |
| Fax Number: | 8164209901 |
| NPI Enumeration Date: | 08/16/2010 |
| NPI Last Update Date: | 08/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 20000152219 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |