Provider Demographics
NPI:1740431709
Name:AMES, ANGELLA L (PT)
Entity Type:Individual
Prefix:
First Name:ANGELLA
Middle Name:L
Last Name:AMES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGELLA
Other - Middle Name:L
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1218 79TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-6111
Mailing Address - Country:US
Mailing Address - Phone:262-658-9500
Mailing Address - Fax:262-658-9621
Practice Address - Street 1:1218 79TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-6111
Practice Address - Country:US
Practice Address - Phone:262-658-9500
Practice Address - Fax:262-658-9621
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5768-0242251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36189800Medicaid