Provider Demographics
NPI:1164721833
Name:ANGELS IN THE OUTFIELD PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ANGELS IN THE OUTFIELD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:318-737-7633
Mailing Address - Street 1:1651 LOUISVILLE AVE STE 123
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6039
Mailing Address - Country:US
Mailing Address - Phone:318-737-7633
Mailing Address - Fax:318-737-7686
Practice Address - Street 1:1651 LOUISVILLE AVE STE 123
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6039
Practice Address - Country:US
Practice Address - Phone:318-737-7633
Practice Address - Fax:318-737-7686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty