Healthcare Provider Details

I. General information

NPI: 1003090366
Provider Name (Legal Business Name): ANGIE PHYSICAL MEDICINE AND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22653 HIGHWAY 21
ANGIE LA
70426
US

IV. Provider business mailing address

22653 HIGHWAY 21
ANGIE LA
70426
US

V. Phone/Fax

Practice location:
  • Phone: 713-894-3576
  • Fax: 713-928-3488
Mailing address:
  • Phone: 713-894-3576
  • Fax: 713-928-3488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: OTIS LEE WELLS
Title or Position: GENERAL MANAGER
Credential:
Phone: 713-894-3576