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NPI Code Detail

MEDICARE: ANGELA RYSTROM

MEDICARE: ANGELA RYSTROM
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 Therapist1239090TX
2225100000XPhysical Therapist2305205039VA

General Provider Information

NPI Number : 1376746719
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA RYSTROM
Provider Business Mailing Address
First Line : 8480 SIGNAL HILL RD
Second Line : APT 402
City : MANASSAS
State : VA
Zip : 20110-7034
Country : US
Telephone Number : 402-720-6639
Fax Number :
Provider Business Practice Location Address
First Line : 2101 AIRLINE RD
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78414-2641
Country : US
Telephone Number : 361-993-4778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2007
Last Update Date : 07/01/2024

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Directions to “ ANGELA RYSTROM ” Practice Location

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