Provider Demographics
NPI:1740215540
Name:WEST, ANGELA K (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:WEST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2485 TOWNE LAKE PKWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8234
Mailing Address - Country:US
Mailing Address - Phone:770-517-7707
Mailing Address - Fax:770-517-7708
Practice Address - Street 1:2485 TOWNE LAKE PKWY
Practice Address - Street 2:SUITE F
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8234
Practice Address - Country:US
Practice Address - Phone:770-517-7707
Practice Address - Fax:770-517-7708
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA3057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist