Provider Demographics
NPI:1629115167
Name:HAIGH, ANGELA MARIA (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:HAIGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIA
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 PARADISE MARSH CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-2139
Mailing Address - Country:US
Mailing Address - Phone:912-262-0820
Mailing Address - Fax:
Practice Address - Street 1:1111 GLYNCO PKWY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-7921
Practice Address - Country:US
Practice Address - Phone:912-264-5377
Practice Address - Fax:912-262-1889
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00762605BMedicaid