Provider Demographics
NPI:1043252588
Name:DICKERSON-SCHNATZ, ANGELA (MPT, OCS, CHT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DICKERSON-SCHNATZ
Suffix:
Gender:F
Credentials:MPT, OCS, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 W CHESTER PIKE STE 150
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-0259
Mailing Address - Country:US
Mailing Address - Phone:610-359-5640
Mailing Address - Fax:610-359-1519
Practice Address - Street 1:1161 MCDERMOTT DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4064
Practice Address - Country:US
Practice Address - Phone:484-356-9401
Practice Address - Fax:484-356-9405
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ100001537225100000X
PAPT014051L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000037864Medicaid
1461970OtherPABS
DE1000038041Medicaid
2146694000OtherAMERIHEALTH IBC
1043252588OtherCHAMPUS TRICARE
5070-0070OtherCAREFIRST
88760504OtherCAREFIRST
2146694000OtherAMERIHEALTH IBC
1461970OtherPABS
1043252588OtherCHAMPUS TRICARE
P00639044Medicare PIN