=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174929715
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ANGELA OSBORN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2014
-----------------------------------------------------
Last Update Date | 11/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1239 E COUNTRYWOOD EST
-----------------------------------------------------
City | HUNTINGBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47542-9507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-631-8577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1239 E COUNTRYWOOD EST
-----------------------------------------------------
City | HUNTINGBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47542-9507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------