Provider Demographics
NPI:1639696040
Name:JOSEPH, ANGELA M (PTA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-5545
Mailing Address - Country:US
Mailing Address - Phone:803-233-4710
Mailing Address - Fax:803-441-0031
Practice Address - Street 1:1241 FRIENDSHIP RD STE 120
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5609
Practice Address - Country:US
Practice Address - Phone:770-415-9792
Practice Address - Fax:770-882-0268
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003485225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant