Provider Demographics
NPI:1639765928
Name:MCERLAIN, ANGELA MARY
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARY
Last Name:MCERLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOULCARE PHYSICAL THERAPY LLC
Mailing Address - Street 2:79 S BENSON RD
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6230
Mailing Address - Country:US
Mailing Address - Phone:203-610-2681
Mailing Address - Fax:
Practice Address - Street 1:79 S BENSON RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6230
Practice Address - Country:US
Practice Address - Phone:203-292-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010417208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation