Healthcare Provider Details

I. General information

NPI: 1457373904
Provider Name (Legal Business Name): MARIE ANN ANGER D.P.T.SC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 INLAND EMPIRE BLVD SUITE 100
ONTARIO CA
91764-5513
US

IV. Provider business mailing address

25787 KELLOGG ST
LOMA LINDA CA
92354-3920
US

V. Phone/Fax

Practice location:
  • Phone: 909-945-3580
  • Fax: 909-989-6158
Mailing address:
  • Phone: 909-557-0578
  • Fax: 909-989-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: