Provider Demographics
NPI:1093802837
Name:ANGUISH, KATIE PROWELL (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:PROWELL
Last Name:ANGUISH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:SUE
Other - Last Name:PROWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 EAST BUTTERNUT COURT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-4870
Mailing Address - Country:US
Mailing Address - Phone:910-274-5221
Mailing Address - Fax:
Practice Address - Street 1:1140 SHIPYARD BOULEVARD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412
Practice Address - Country:US
Practice Address - Phone:910-799-4199
Practice Address - Fax:910-799-1616
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist