Provider Demographics
NPI:1629732458
Name:NORMAN, ANGELA (DPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 S CARRIER PKWY STE 490
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-6668
Mailing Address - Country:US
Mailing Address - Phone:214-324-5851
Mailing Address - Fax:214-324-5728
Practice Address - Street 1:718 N BUCKNER BLVD STE 118
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2764
Practice Address - Country:US
Practice Address - Phone:214-324-5851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1351584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist