Provider Demographics
NPI:1710607775
Name:WHALEY, ANGELICA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:WHALEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COVE XING
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5989
Mailing Address - Country:US
Mailing Address - Phone:678-416-1415
Mailing Address - Fax:
Practice Address - Street 1:834 INMAN VILLAGE PKWY NE STE 130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-5502
Practice Address - Country:US
Practice Address - Phone:404-618-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist