Provider Demographics
NPI:1063673101
Name:ROBERTS, ANGELA MARY (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 E ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6723
Mailing Address - Country:US
Mailing Address - Phone:714-279-6001
Mailing Address - Fax:
Practice Address - Street 1:2031 E ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6723
Practice Address - Country:US
Practice Address - Phone:714-279-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist