Provider Demographics
NPI:1659037687
Name:WEATHERSPOON, ANGELICA (PT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:WEATHERSPOON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16306 HIGHWAY 69 S
Mailing Address - Street 2:
Mailing Address - City:MOUNDVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35474-6213
Mailing Address - Country:US
Mailing Address - Phone:205-861-6523
Mailing Address - Fax:
Practice Address - Street 1:1718 VETERANS MEMORIAL PKWY STE A
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-4792
Practice Address - Country:US
Practice Address - Phone:205-270-5146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist