Provider Demographics
NPI:1821368309
Name:AUBRY, ANGELA SUE (PTA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:SUE
Last Name:AUBRY
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 1:2015 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-2219
Mailing Address - Country:US
Mailing Address - Phone:715-923-8269
Mailing Address - Fax:
Practice Address - Street 1:2015 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-2219
Practice Address - Country:US
Practice Address - Phone:715-923-8269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1627-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant