Provider Demographics
NPI:1083846232
Name:DEBERRY, ANGELA SPATES (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SPATES
Last Name:DEBERRY
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 1:4236 MOUNTAIN GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3893
Mailing Address - Country:US
Mailing Address - Phone:804-320-5629
Mailing Address - Fax:
Practice Address - Street 1:1000 TWINRIDGE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5248
Practice Address - Country:US
Practice Address - Phone:804-320-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist