Healthcare Provider Details

I. General information

NPI: 1255111811
Provider Name (Legal Business Name): ANGELA MARIE BLANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 N COUNTY ROAD 500 W
BROWNSTOWN IN
47220-7800
US

IV. Provider business mailing address

3234 N COUNTY ROAD 500 W
BROWNSTOWN IN
47220-7800
US

V. Phone/Fax

Practice location:
  • Phone: 812-216-7912
  • Fax:
Mailing address:
  • Phone: 812-216-1386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002215A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: