Basic Information
| Provider Information | |||||||||
| NPI: | 1174713291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MABERRY | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1454 STATE HIGHWAY 70 S | ||||||||
| Address2: | |||||||||
| City: | SWEETWATER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795566112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3252354992 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1934 HICKORY | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3252351701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2007 | ||||||||
| LastUpdateDate: | 03/31/2011 | ||||||||
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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 | 2251P0200X | 1133270 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.