Provider Demographics
NPI:1083055776
Name:SMITH, ANGELA RENE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 WOODLEY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1175
Mailing Address - Country:US
Mailing Address - Phone:419-724-5582
Mailing Address - Fax:
Practice Address - Street 1:3840 WOODLEY RD
Practice Address - Street 2:SUITE D
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1175
Practice Address - Country:US
Practice Address - Phone:419-724-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.009960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHPENDINGMedicare PIN