Provider Demographics
NPI:1659443752
Name:ALLEY, ANGELA J (RN, BSN, MPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:ALLEY
Suffix:
Gender:F
Credentials:RN, BSN, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8101
Mailing Address - Country:US
Mailing Address - Phone:423-844-4107
Mailing Address - Fax:423-844-4149
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-4107
Practice Address - Fax:423-844-4149
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6398225100000X
TN108644163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No163W00000XNursing Service ProvidersRegistered Nurse