Healthcare Provider Details

I. General information

NPI: 1629460654
Provider Name (Legal Business Name): KAREN ANGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 DOUGLAS CIR
KEY WEST FL
33040-4536
US

IV. Provider business mailing address

201 CAMINO REAL
MARATHON FL
33050-2474
US

V. Phone/Fax

Practice location:
  • Phone: 305-293-4863
  • Fax:
Mailing address:
  • Phone: 305-731-6219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 20132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: