Provider Demographics
NPI:1962655852
Name:ANGELIC REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:ANGELIC REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:740-249-4081
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-0742
Mailing Address - Country:US
Mailing Address - Phone:740-249-4081
Mailing Address - Fax:740-249-4126
Practice Address - Street 1:86 COLUMBUS CIRCLE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1331
Practice Address - Country:US
Practice Address - Phone:740-249-4081
Practice Address - Fax:740-249-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2934918Medicaid
OH9379791Medicare PIN