Provider Demographics
NPI:1043505217
Name:THODE, ANGELA AGNES (PTA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:AGNES
Last Name:THODE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 FAHRNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-3260
Mailing Address - Country:US
Mailing Address - Phone:641-777-2530
Mailing Address - Fax:
Practice Address - Street 1:513 FAHRNEY BLVD
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3260
Practice Address - Country:US
Practice Address - Phone:641-777-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00308225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant