Provider Demographics
NPI:1417188798
Name:STURGILL, ANGIE (PTA)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:STURGILL
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 1:1083 TOWNSHIP ROAD 1806
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9404
Mailing Address - Country:US
Mailing Address - Phone:567-203-7859
Mailing Address - Fax:
Practice Address - Street 1:1083 TOWNSHIP ROAD 1806
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9404
Practice Address - Country:US
Practice Address - Phone:567-203-7859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05892225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant