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General NPI Number Information
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NPI Number | 1164721833
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Entity Type | Organization
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Legal Business Name | ANGELS IN THE OUTFIELD PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 1651 LOUISVILLE AVE STE 123
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City | MONROE
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State | LA
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Zip | 71201-6039
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Country | US
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Telephone | 318-737-7633
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Fax | 318-737-7686
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Provider Business Mailing Address
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Address Line | 1651 LOUISVILLE AVE STE 123
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City | MONROE
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State | LA
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Zip | 71201-6039
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Country | US
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Telephone | 318-737-7633
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Fax | 318-737-7686
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. ANGELA MARIE DUNN
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Credential | PHYSICAL THERAPIST
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Telephone | 318-737-7633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 04196
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License Number State | LA
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