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General NPI Number Information
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NPI Number | 1942945928
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Entity Type | Individual
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Provider Name | DESTINY ANGTON ME.D, LAT
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Gender | Female
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 1600 S LOOP 256
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City | PALESTINE
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State | TX
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Zip | 75801-5847
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Country | US
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Telephone | 903-731-8005
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Fax |
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Provider Business Mailing Address
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Address Line | 100 DAMON ALLEN WAY APT 5105
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City | PALESTINE
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State | TX
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Zip | 75801-0021
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Country | US
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Telephone | 214-724-2087
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT8514
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License Number State | TX
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