Basic Information
| Provider Information | |||||||||
| NPI: | 1225468069 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANGELUS PHYSICAL THERAPIST INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 E SCHUSTER AVE | ||||||||
| Address2: | 9A | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799024350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155444100 | ||||||||
| FaxNumber: | 9155444102 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 E SCHUSTER AVE | ||||||||
| Address2: | STE 9A | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799024350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152745937 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2013 | ||||||||
| LastUpdateDate: | 07/25/2014 | ||||||||
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| AuthorizedOfficialLastName: | ACOSTA | ||||||||
| AuthorizedOfficialFirstName: | ANGELICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9152745937 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1136828 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.