Provider Demographics
NPI:1790990026
Name:MESEROLE, ANGELA (ATC, NASM-PES)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MESEROLE
Suffix:
Gender:F
Credentials:ATC, NASM-PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HOPE DR
Mailing Address - Street 2:APT. #1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-3983
Mailing Address - Country:US
Mailing Address - Phone:814-898-7227
Mailing Address - Fax:
Practice Address - Street 1:5103 STATION ROAD
Practice Address - Street 2:PENN STATE BEHREND
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16563-0400
Practice Address - Country:US
Practice Address - Phone:814-898-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0031542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer