Basic Information
| Provider Information | |||||||||
| NPI: | 1952603920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTANEDA | ||||||||
| FirstName: | ANGELA CELINA | ||||||||
| MiddleName: | ALCALA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALCALA | ||||||||
| OtherFirstName: | ANGELA CELINA | ||||||||
| OtherMiddleName: | BELARMINO | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 329 13TH ST | ||||||||
| Address2: | |||||||||
| City: | TELL CITY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475861820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732309716 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 604 RENNAKER ST | ||||||||
| Address2: | |||||||||
| City: | LA FONTAINE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469409045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659812081 | ||||||||
| FaxNumber: | 7659814954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2010 | ||||||||
| LastUpdateDate: | 11/24/2010 | ||||||||
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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 | 5009748A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.