Provider Demographics
NPI:1003090366
Name:ANGIE PHYSICAL MEDICINE AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:ANGIE PHYSICAL MEDICINE AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-894-3576
Mailing Address - Street 1:22653 HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:ANGIE
Mailing Address - State:LA
Mailing Address - Zip Code:70426
Mailing Address - Country:US
Mailing Address - Phone:713-894-3576
Mailing Address - Fax:713-928-3488
Practice Address - Street 1:22653 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:ANGIE
Practice Address - State:LA
Practice Address - Zip Code:70426
Practice Address - Country:US
Practice Address - Phone:713-894-3576
Practice Address - Fax:713-928-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty