Provider Demographics
NPI:1477085272
Name:CHANG, ANGELA LEE (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LEE
Last Name:CHANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:8022 WHITE JASMINE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4983
Mailing Address - Country:US
Mailing Address - Phone:443-768-4300
Mailing Address - Fax:
Practice Address - Street 1:2401 RESEARCH BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3215
Practice Address - Country:US
Practice Address - Phone:877-221-2981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist