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NPI Code Detail

MEDICARE: NANCY WANGEN P.T.A.

MEDICARE: NANCY WANGEN P.T.A.
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
1225200000XPhysical Therapy Assistant2053843TX

General Provider Information

NPI Number : 1649569104
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY WANGEN P.T.A.
Provider Business Mailing Address
First Line : 3114 LUCIDA LN
Second Line :
City : SPRING
State : TX
Zip : 77373-6660
Country : US
Telephone Number : 281-353-7972
Fax Number :
Provider Business Practice Location Address
First Line : 4650 S PANTHER CREEK DR
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77381-2764
Country : US
Telephone Number : 281-681-1141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2011
Last Update Date : 04/05/2011

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