Provider Demographics
NPI:1629177654
Name:RIGDON, ANGELA KAPICAK (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAPICAK
Last Name:RIGDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:KAPICAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4651 NIXON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9759
Mailing Address - Country:US
Mailing Address - Phone:315-492-0592
Mailing Address - Fax:
Practice Address - Street 1:4651 NIXON PARK DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9759
Practice Address - Country:US
Practice Address - Phone:315-492-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022191-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02408708Medicaid
NYDD5848Medicare ID - Type Unspecified
NY02408708Medicaid