Provider Demographics
NPI:1831100171
Name:RICH, ANGELA J (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:RICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W 35TH ST
Mailing Address - Street 2:BLDG E
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1434
Mailing Address - Country:US
Mailing Address - Phone:512-302-5551
Mailing Address - Fax:512-302-5553
Practice Address - Street 1:1515 W 35TH ST
Practice Address - Street 2:BLDG E
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1434
Practice Address - Country:US
Practice Address - Phone:512-302-5551
Practice Address - Fax:512-302-5553
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10930782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX659516OtherBCBS PROVIDER NUMBER
TX650511Medicare UPIN