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General NPI Number Information
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NPI Number | 1730662743
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Entity Type | Individual
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Provider Name | ANGIE LEE GILFILLAN PTA
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Gender | Female
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 415 HIGHWAY 377 S STE 200
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City | ARGYLE
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State | TX
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Zip | 76226-5140
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Country | US
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Telephone | 918-261-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 19744 W 23RD ST S
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City | HASKELL
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State | OK
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Zip | 74436-6226
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Country | US
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Telephone | 918-261-6191
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1091
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License Number State | OK
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