Provider Demographics
NPI:1518038173
Name:GRUNKEMEYER, ANGELA L (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:L
Last Name:GRUNKEMEYER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:3631 N MORRISON RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5547
Mailing Address - Country:US
Mailing Address - Phone:765-281-3443
Mailing Address - Fax:
Practice Address - Street 1:3631 N MORRISON RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5547
Practice Address - Country:US
Practice Address - Phone:765-281-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist