Provider Demographics
NPI:1467669846
Name:ANG, SANJEE BENJAMIN G (PT)
Entity Type:Individual
Prefix:
First Name:SANJEE BENJAMIN
Middle Name:G
Last Name:ANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-4423
Mailing Address - Country:US
Mailing Address - Phone:319-601-9768
Mailing Address - Fax:877-717-9680
Practice Address - Street 1:1850 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-4423
Practice Address - Country:US
Practice Address - Phone:319-601-9768
Practice Address - Fax:877-717-9680
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist