Provider Demographics
NPI:1427196971
Name:CADENBACH, ANGIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:CADENBACH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:AR
Mailing Address - Zip Code:72531-0041
Mailing Address - Country:US
Mailing Address - Phone:870-371-1254
Mailing Address - Fax:870-895-2626
Practice Address - Street 1:679 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576
Practice Address - Country:US
Practice Address - Phone:870-895-6006
Practice Address - Fax:870-895-2626
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003027444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO489235606Medicaid