Provider Demographics
NPI:1003397175
Name:IMPERIAL, NADIA ANGELIQUE DUMALASA
Entity Type:Individual
Prefix:
First Name:NADIA ANGELIQUE
Middle Name:DUMALASA
Last Name:IMPERIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-5611
Mailing Address - Country:US
Mailing Address - Phone:903-677-5864
Mailing Address - Fax:
Practice Address - Street 1:150 GIBSON RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-5611
Practice Address - Country:US
Practice Address - Phone:903-677-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist