Provider Demographics
NPI:1538102488
Name:PARKER, ANGELA LESTOURGEON (MS, PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LESTOURGEON
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:LESTOURGEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-282-6338
Practice Address - Fax:804-285-3237
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00761610OtherRR MEDICARE
VA008953104Medicaid
VAP00761610OtherRR MEDICARE
VA008953104Medicaid