Provider Demographics
NPI:1598904492
Name:SORG, ANGELA CATHERINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CATHERINE
Last Name:SORG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:CATHERINE
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:238 ASH ST
Mailing Address - Street 2:
Mailing Address - City:ST. MARY'S
Mailing Address - State:PA
Mailing Address - Zip Code:15857-1660
Mailing Address - Country:US
Mailing Address - Phone:814-594-2660
Mailing Address - Fax:
Practice Address - Street 1:110 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-362-6535
Practice Address - Fax:814-887-5666
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014338240001Medicaid