Provider Demographics
NPI:1760182059
Name:ANGARITA, MARISSA KATE (PTA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:KATE
Last Name:ANGARITA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6821
Mailing Address - Country:US
Mailing Address - Phone:843-521-1970
Mailing Address - Fax:
Practice Address - Street 1:1900 BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6821
Practice Address - Country:US
Practice Address - Phone:843-521-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4892225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant