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General NPI Number Information
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NPI Number | 1053574400
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Entity Type | Individual
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Provider Name | ANGELA GRAYCE TREADWAY DPT
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Gender | Female
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 4107 MEDICAL PKWY STE 100
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City | AUSTIN
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State | TX
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Zip | 78756-3736
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Country | US
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Telephone | 512-851-7070
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Fax | 949-561-4547
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Provider Business Mailing Address
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Address Line | 110 IH 35 N # 315-227
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City | ROUND ROCK
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State | TX
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Zip | 78681-5003
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Country | US
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Telephone | 512-851-7070
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Fax | 949-561-4547
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1113611
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License Number State | TX
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