Provider Demographics
NPI:1689884991
Name:ANGELA K PRESCOTT
Entity Type:Organization
Organization Name:ANGELA K PRESCOTT
Other - Org Name:LA QUINTA PHYSICAL THERAPY DBA PRESCOTTS SPORTS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER LICENSED PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KAYLENE
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-324-6400
Mailing Address - Street 1:78365 HIGHWAY 111
Mailing Address - Street 2:SUITE # 167
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2071
Mailing Address - Country:US
Mailing Address - Phone:760-324-6400
Mailing Address - Fax:760-328-8216
Practice Address - Street 1:78365 HIGHWAY 111
Practice Address - Street 2:SUITE167
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2071
Practice Address - Country:US
Practice Address - Phone:760-324-6400
Practice Address - Fax:760-328-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251S0007X2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT193551OtherMEDICARE PTAN INDIVIDUAL
CAZZZ29525ZOtherMEDICARE PTAN GROUP
CAY10882Medicare UPIN
CAZZZ29525ZMedicare PIN
CAZZZ29525ZOtherMEDICARE PTAN GROUP