MEDICARE: ANGELA CHRISTINE MCCORMICK P.T.

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	208100000X	Physical Medicine & Rehabilitation Physician	03655	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00137447	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	F232553	OTHER	IA	MIDLANDS CHOICE
4	12250	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1639197015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA CHRISTINE MCCORMICK P.T.

Provider Business Mailing Address
First Line	:	3376 66TH ST
Second Line	:
City	:	PALO
State	:	IA
Zip	:	52324-9621
Country	:	US
Telephone Number	:	319-436-4811
Fax Number	:	319-363-2903

Provider Business Practice Location Address
First Line	:	625 32ND AVE SW
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52404-3947
Country	:	US
Telephone Number	:	319-363-2901
Fax Number	:	319-363-2903

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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