Basic Information
| Provider Information | |||||||||
| NPI: | 1750601522 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | ANGELICA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | PT | ||||||||
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| OtherLastName: | GARRETT | ||||||||
| OtherFirstName: | ANGEL | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 223 LEGACY LN | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460321635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173318459 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10601 N MERIDIAN ST | ||||||||
| Address2: | STE 110 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462901152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175752100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 04/12/2013 | ||||||||
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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 | 05008749A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.