Basic Information
| Provider Information | |||||||||
| NPI: | 1508420878 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VANSKIKE | ||||||||
| FirstName: | ANGEL | ||||||||
| MiddleName: | LOU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 524 WRIGHT AVE | ||||||||
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| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011615 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 S CRAPO ST | ||||||||
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| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897735918 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2019 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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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 | 225200000X | 5502001705 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.