Provider Demographics
NPI:1376981449
Name:CORALES, ANGELINA C (PT)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:C
Last Name:CORALES
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 1:3000 SEVERN AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7605
Mailing Address - Country:US
Mailing Address - Phone:504-885-8969
Mailing Address - Fax:
Practice Address - Street 1:3000 SEVERN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-7605
Practice Address - Country:US
Practice Address - Phone:504-885-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist