Healthcare Provider Details

I. General information

NPI: 1699759571
Provider Name (Legal Business Name): ANGELA RENEE LANDSETTLE PT 010884
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA RENEE WARNOCK PT 010884

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 STOCKSDALE DR
MARYSVILLE OH
43040-5507
US

IV. Provider business mailing address

211 STOCKSDALE DR
MARYSVILLE OH
43040-5507
US

V. Phone/Fax

Practice location:
  • Phone: 937-644-3311
  • Fax: 937-644-0373
Mailing address:
  • Phone: 937-644-3311
  • Fax: 937-644-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 010884
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: