Provider Demographics
NPI:1578987277
Name:WEST, ANGELA (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 STONECREST DR
Mailing Address - Street 2:APT B3
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-7831
Mailing Address - Country:US
Mailing Address - Phone:336-260-4730
Mailing Address - Fax:
Practice Address - Street 1:2502 S NC HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9565
Practice Address - Country:US
Practice Address - Phone:336-578-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-15
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist