Provider Demographics
NPI:1073053096
Name:EMERSON, ANGELA HARRIS (ATC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:HARRIS
Last Name:EMERSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1609 DALE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAVISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24517-1225
Mailing Address - Country:US
Mailing Address - Phone:434-369-5307
Mailing Address - Fax:
Practice Address - Street 1:904 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517-1915
Practice Address - Country:US
Practice Address - Phone:434-369-4768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer