MEDICARE: MRS. VICTORIA D ANGLIN PTA

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
1	225200000X	Physical Therapy Assistant	PTA001659	GA

General Provider Information

NPI Number	:	1154443620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA D ANGLIN PTA

Provider Business Mailing Address
First Line	:	1725 PARKHILL DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-4519
Country	:	US
Telephone Number	:	678-754-1375
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 PEACHTREE RD NE
Second Line	:	SUITE D-336
City	:	ATLANTA
State	:	GA
Zip	:	30309-1148
Country	:	US
Telephone Number	:	404-351-5307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	05/15/2015

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