Healthcare Provider Details

I. General information

NPI: 1760138903
Provider Name (Legal Business Name): ANGELA MARIE CIPOLLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HIGH ST
WILLIAMSPORT PA
17701-3100
US

IV. Provider business mailing address

2314 LINCOLN DR
WILLIAMSPORT PA
17701-4045
US

V. Phone/Fax

Practice location:
  • Phone: 570-321-2622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI005759
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: