Provider Demographics
NPI:1922405364
Name:ENGLE, ANN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:ENGLE
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 1:3706 WOODLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9307
Mailing Address - Country:US
Mailing Address - Phone:318-218-6717
Mailing Address - Fax:
Practice Address - Street 1:3706 WOODLAKE CIR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-9307
Practice Address - Country:US
Practice Address - Phone:318-218-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA8984225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant