Provider Demographics
NPI:1508299033
Name:BLATNER, ANGELA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:BLATNER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4644
Mailing Address - Country:US
Mailing Address - Phone:630-462-6723
Mailing Address - Fax:
Practice Address - Street 1:201 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4644
Practice Address - Country:US
Practice Address - Phone:630-462-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist