Provider Demographics
NPI:1457510240
Name:LOVELL, ANGELIA KAY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:KAY
Last Name:LOVELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:KAY
Other - Last Name:LOVELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1300 NE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 NE 16TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97323
Practice Address - Country:US
Practice Address - Phone:503-288-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8351225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant