Provider Demographics
NPI:1093180879
Name:BEAVER, ANGELA G (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:G
Last Name:BEAVER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:GAUNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 GREENBRIER RD
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-9703
Mailing Address - Country:US
Mailing Address - Phone:304-763-5121
Mailing Address - Fax:
Practice Address - Street 1:204 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9703
Practice Address - Country:US
Practice Address - Phone:304-890-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist