Provider Demographics
NPI:1952688244
Name:WAKEFIELD, ANGELA LYNN (MPT, DSCPT)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYNN
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:MPT, DSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1 CARMANS RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1438
Mailing Address - Country:US
Mailing Address - Phone:516-608-6200
Mailing Address - Fax:516-541-7368
Practice Address - Street 1:1 CARMANS RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-1438
Practice Address - Country:US
Practice Address - Phone:516-608-6200
Practice Address - Fax:516-541-7368
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0189982251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology