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NPI Code Detail

MEDICARE: DR. ANGELA GRAYCE TREADWAY DPT

MEDICARE: DR. ANGELA GRAYCE TREADWAY DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1113611TX

General Provider Information

NPI Number : 1053574400
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELA GRAYCE TREADWAY DPT
Provider Business Mailing Address
First Line : 110 IH 35 N # 315-227
Second Line :
City : ROUND ROCK
State : TX
Zip : 78681-5003
Country : US
Telephone Number : 512-851-7070
Fax Number : 949-561-4547
Provider Business Practice Location Address
First Line : 4107 MEDICAL PKWY STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78756-3736
Country : US
Telephone Number : 512-851-7070
Fax Number : 949-561-4547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2008
Last Update Date : 02/16/2021

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