Provider Demographics
NPI:1083800205
Name:AITKEN, ANGELA (DPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:AITKEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 BRICK CHURCH PIKE
Mailing Address - Street 2:
Mailing Address - City:WHITES CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37189-9147
Mailing Address - Country:US
Mailing Address - Phone:615-283-0170
Mailing Address - Fax:
Practice Address - Street 1:4099 BRICK CHURCH PIKE
Practice Address - Street 2:
Practice Address - City:WHITES CREEK
Practice Address - State:TN
Practice Address - Zip Code:37189-9147
Practice Address - Country:US
Practice Address - Phone:615-283-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2020-02-19
Deactivation Date:2019-02-20
Deactivation Code:
Reactivation Date:2020-02-19
Provider Licenses
StateLicense IDTaxonomies
TN7879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731301Medicaid
TN3731301Medicare Oscar/Certification
TN3731301Medicare UPIN
TN3731301Medicare PIN