Provider Demographics
NPI:1538502612
Name:MAXWELL, ANGELA MICHELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MICHELLE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:DECATURVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38329-5629
Mailing Address - Country:US
Mailing Address - Phone:731-549-0922
Mailing Address - Fax:
Practice Address - Street 1:580 TENNESSEE AVE N
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2624
Practice Address - Country:US
Practice Address - Phone:731-847-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4186225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant