Provider Demographics
NPI:1093287393
Name:CREIGHTON, ANGELA R (PTA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:CREIGHTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 SILVERBELL CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6748
Mailing Address - Country:US
Mailing Address - Phone:219-363-5901
Mailing Address - Fax:
Practice Address - Street 1:100 JOSEPH WALKER DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6971
Practice Address - Country:US
Practice Address - Phone:803-796-0370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3759225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant