Basic Information
| Provider Information | |||||||||
| NPI: | 1770621476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PTA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FIDLER | ||||||||
| OtherFirstName: | ANGELA | ||||||||
| OtherMiddleName: | BETH | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 401 REDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197569773 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 536 SOUTH TRIMBLE RD | ||||||||
| Address2: | MANSFIELD ORTHOPAEDIC SURGERY & RHEUMATOLOGY | ||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197568899 | ||||||||
| FaxNumber: | 4197566004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | PTA04008 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.