Healthcare Provider Details

I. General information

NPI: 1649396490
Provider Name (Legal Business Name): ANGELA RENEE WESTENDORF PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 COLLEGE ST
CEDAR FALLS IA
50613-2500
US

IV. Provider business mailing address

508 CATALINA AVENUE
WAVERLY IA
50677-3940
US

V. Phone/Fax

Practice location:
  • Phone: 319-268-3000
  • Fax:
Mailing address:
  • Phone: 319-352-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number000122
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: