Provider Demographics
NPI:1821231598
Name:NEELY, ANGELA VERNETTE (LPTA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:VERNETTE
Last Name:NEELY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:VERNETTE
Other - Last Name:NEELY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPTA
Mailing Address - Street 1:418 ASHBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-9103
Mailing Address - Country:US
Mailing Address - Phone:704-636-3038
Mailing Address - Fax:
Practice Address - Street 1:418 ASHBROOK RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-9103
Practice Address - Country:US
Practice Address - Phone:704-636-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC379225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant