Healthcare Provider Details

I. General information

NPI: 1154443620
Provider Name (Legal Business Name): VICTORIA D ANGLIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 PEACHTREE RD NE SUITE D-336
ATLANTA GA
30309-1148
US

IV. Provider business mailing address

1725 PARKHILL DR
DECATUR GA
30032-4519
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-5307
  • Fax:
Mailing address:
  • Phone: 678-754-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA001659
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: