Provider Demographics
NPI:1710136403
Name:FEARS, ANGELA (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:FEARS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 S VAL VISTA DR
Mailing Address - Street 2:STE 187
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1675
Mailing Address - Country:US
Mailing Address - Phone:866-846-1265
Mailing Address - Fax:866-846-1265
Practice Address - Street 1:2730 S VAL VISTA DR
Practice Address - Street 2:STE 187
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1675
Practice Address - Country:US
Practice Address - Phone:866-846-1265
Practice Address - Fax:866-846-1265
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-05263172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist