MEDICARE: MRS. CYNTHIA DEAREN ANGEL P.T.

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
1	2251P0200X	Pediatric Physical Therapist	001402	KY

General Provider Information

NPI Number	:	1750322889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA DEAREN ANGEL P.T.

Provider Business Mailing Address
First Line	:	1305 HANDY RD
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-8789
Country	:	US
Telephone Number	:	859-613-4124
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 HANDY RD
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-8789
Country	:	US
Telephone Number	:	859-613-4124
Fax Number	:	859-748-6006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	06/03/2020

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