Provider Demographics
NPI:1518177039
Name:OBREN, ANGELA GIGI (MSPT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:GIGI
Last Name:OBREN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3073
Mailing Address - Street 2:
Mailing Address - City:VALDEZ
Mailing Address - State:AK
Mailing Address - Zip Code:99686-3073
Mailing Address - Country:US
Mailing Address - Phone:907-835-9565
Mailing Address - Fax:
Practice Address - Street 1:911 MEALS AVENUE
Practice Address - Street 2:
Practice Address - City:VALDEZ
Practice Address - State:AK
Practice Address - Zip Code:99686
Practice Address - Country:US
Practice Address - Phone:907-834-1862
Practice Address - Fax:907-834-1890
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist