Provider Demographics
NPI:1952457582
Name:MOFFITT, ANGELA (PTA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:534 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4114
Mailing Address - Country:US
Mailing Address - Phone:940-566-5714
Mailing Address - Fax:940-381-0157
Practice Address - Street 1:534 N ELM ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4114
Practice Address - Country:US
Practice Address - Phone:940-566-5714
Practice Address - Fax:940-381-0157
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2041911225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant