Provider Demographics
NPI:1851513048
Name:COX, ANGELA D (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:COX
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 1:331 COUNTY ROAD 611
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-0804
Mailing Address - Country:US
Mailing Address - Phone:325-643-1721
Mailing Address - Fax:325-646-7627
Practice Address - Street 1:408 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-1639
Practice Address - Country:US
Practice Address - Phone:325-643-1721
Practice Address - Fax:325-646-7627
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-8604-9225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107978201Medicaid