Provider Demographics
NPI:1679608855
Name:LAND, ANGELA D (RPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:LAND
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:711 GENN DRIVE WAMEGO HOSPITAL ASSOCIATION
Mailing Address - Street 2:DBA WAMEGO HEALTH CENTER AND WAMEGO FAMILY CLINIC
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547
Mailing Address - Country:US
Mailing Address - Phone:785-456-2295
Mailing Address - Fax:785-456-6916
Practice Address - Street 1:711 GENN DRIVE WAMEGO HOSPITAL ASSOCIATION
Practice Address - Street 2:DBA WAMEGO HEALTH CENTER AND WAMEGO FAMILY CLINIC
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547
Practice Address - Country:US
Practice Address - Phone:785-456-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1102565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140968Medicare ID - Type Unspecified