Healthcare Provider Details

I. General information

NPI: 1245467901
Provider Name (Legal Business Name): ANGELA LEE FITCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9910 HUEBNER RD
SAN ANTONIO TX
78240-1342
US

IV. Provider business mailing address

61 SABLE CYN
SAN ANTONIO TX
78258-4857
US

V. Phone/Fax

Practice location:
  • Phone: 210-691-0039
  • Fax: 210-699-0136
Mailing address:
  • Phone: 210-542-4892
  • Fax: 210-699-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1098689
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: