Provider Demographics
NPI:1558607986
Name:WITT, ANGELA COLEMAN (ATC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:COLEMAN
Last Name:WITT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 UNIVERSITY BLVD
Mailing Address - Street 2:ICE CENTER
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2269
Mailing Address - Country:US
Mailing Address - Phone:434-592-6390
Mailing Address - Fax:434-522-0549
Practice Address - Street 1:1971 UNIVERSITY BLVD
Practice Address - Street 2:ICE CENTER
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2269
Practice Address - Country:US
Practice Address - Phone:434-592-6390
Practice Address - Fax:434-522-0549
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260003482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer