Provider Demographics
NPI:1942945928
Name:ANGTON, DESTINY (MED, LAT)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:ANGTON
Suffix:
Gender:F
Credentials:MED, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DAMON ALLEN WAY APT 5105
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-0021
Mailing Address - Country:US
Mailing Address - Phone:214-724-2087
Mailing Address - Fax:
Practice Address - Street 1:1600 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5847
Practice Address - Country:US
Practice Address - Phone:903-731-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT85142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer