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NPI Code Detail

MEDICARE: MISS ANGELA KOULAX PT

MEDICARE: MISS ANGELA KOULAX PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist15702MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1469807OTHERMATUFTS
2Y68023OTHERMABLUE SHIELD
357018OTHERMAFALLON
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295707271
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ANGELA KOULAX PT
Provider Business Mailing Address
First Line : 319A SOUTHBRIDGE ST
Second Line :
City : AUBURN
State : MA
Zip : 01501-2598
Country : US
Telephone Number : 508-832-2628
Fax Number :
Provider Business Practice Location Address
First Line : 319A SOUTHBRIDGE ST
Second Line :
City : AUBURN
State : MA
Zip : 01501-2598
Country : US
Telephone Number : 508-832-2628
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 07/08/2007

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Directions to “ MISS ANGELA KOULAX PT” Practice Location

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