Provider Demographics
NPI:1053498543
Name:TANAKA, ANGELA KAYE MOORE (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:KAYE MOORE
Last Name:TANAKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3068 SWAPS DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7468
Mailing Address - Country:US
Mailing Address - Phone:435-579-3494
Mailing Address - Fax:435-213-2691
Practice Address - Street 1:352 E RIVERSIDE DR STE A6
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6999
Practice Address - Country:US
Practice Address - Phone:204-355-7934
Practice Address - Fax:435-213-2691
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist