Provider Demographics
NPI:1457680290
Name:ING, ANGELA KAY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAY
Last Name:ING
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 1:9355 BAXTER RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-6143
Mailing Address - Country:US
Mailing Address - Phone:618-923-1115
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:GALATIA
Practice Address - State:IL
Practice Address - Zip Code:62935-1202
Practice Address - Country:US
Practice Address - Phone:618-268-4631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.000901225200000X
IN06000726A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant