Provider Demographics
NPI:1619913662
Name:PRESCOTT, ANGELA K (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:K
Last Name:PRESCOTT
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 1:78445 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2076
Mailing Address - Country:US
Mailing Address - Phone:760-564-3414
Mailing Address - Fax:760-777-9545
Practice Address - Street 1:78445 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2076
Practice Address - Country:US
Practice Address - Phone:760-564-3414
Practice Address - Fax:760-777-9545
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY10882Medicare UPIN
CA0PT193551Medicare PIN
CA0PT193552Medicare PIN