Provider Demographics
NPI:1790723039
Name:REEVES, ANGELA LYNN (MSPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:REEVES
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:DODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:7937 RHEA COUNTY HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5990
Practice Address - Country:US
Practice Address - Phone:423-570-0907
Practice Address - Fax:423-570-0936
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441654Medicaid
TN0446652Medicaid
TN3646803Medicaid
TN3156797OtherBCBST - GROUP NUMBER
TN0446652Medicaid