Provider Demographics
NPI:1427223924
Name:JANGALA, THERESA A (LICENSED PHYSICAL TH)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:JANGALA
Suffix:
Gender:F
Credentials:LICENSED PHYSICAL TH
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1403 MILL RACE DRIVE
Mailing Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-444-0526
Mailing Address - Fax:540-444-0531
Practice Address - Street 1:126 MILL LANE
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA SALEM
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-387-4311
Practice Address - Fax:540-389-6212
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2306000557225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant