Healthcare Provider Details

I. General information

NPI: 1376687277
Provider Name (Legal Business Name): ANGELA JO HUFFMAN MS,PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 BEISINGER PL
INDIANAPOLIS IN
46237-3101
US

IV. Provider business mailing address

5711 BEISINGER PL
INDIANAPOLIS IN
46237-3101
US

V. Phone/Fax

Practice location:
  • Phone: 317-431-6762
  • Fax: 317-780-0969
Mailing address:
  • Phone: 317-431-6762
  • Fax: 317-780-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05003090A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: