=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598905234
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA INEZ SORRELL PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2009
-----------------------------------------------------
Last Update Date | 02/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3355 CHERRY RIDGE ST STE 209
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-366-1575
-----------------------------------------------------
Fax | 210-366-1572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3355 CHERRY RIDGE ST STE 209
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-366-1575
-----------------------------------------------------
Fax | 210-366-1572
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1134617
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------