Healthcare Provider Details

I. General information

NPI: 1316925712
Provider Name (Legal Business Name): CARMEN L ANGLIN DPT, CMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARMEN L WILKINS

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 1ST ST
STAYTON OR
97383-1704
US

IV. Provider business mailing address

601 N 1ST ST
STAYTON OR
97383-1704
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-3123
  • Fax: 503-769-3176
Mailing address:
  • Phone: 503-769-3123
  • Fax: 503-769-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4422
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: