Healthcare Provider Details

I. General information

NPI: 1699223511
Provider Name (Legal Business Name): ANGELA WILLIAMS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 W BRADLEY RD
MILWAUKEE WI
53223-3325
US

IV. Provider business mailing address

6735 W BRADLEY RD
MILWAUKEE WI
53223-3325
US

V. Phone/Fax

Practice location:
  • Phone: 414-354-3300
  • Fax: 414-371-2390
Mailing address:
  • Phone: 414-354-3300
  • Fax: 414-371-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number326714
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2444
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: