Basic Information
| Provider Information | |||||||||
| NPI: | 1114017985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUMRELL | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1908 FLINT RD SE | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356016031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563409708 | ||||||||
| FaxNumber: | 2563409624 | ||||||||
| Practice Location | |||||||||
| Address1: | 4528 EASY ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ORANGE BEACH | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365615845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519811300 | ||||||||
| FaxNumber: | 2519811305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 02/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH 4823 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | DB9027 | 01 | AL | RAILROAD MEDICARE FROUP | OTHER | 1003819608 | 01 | AL | NPI GROUP | OTHER | 515-39070 | 01 | AL | BCBS | OTHER | 890019420 | 05 | AL | MEDICAID |