Provider Demographics
NPI:1134551963
Name:MABALOT, ANGELA BOWERS (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:BOWERS
Last Name:MABALOT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 DARLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6765
Mailing Address - Country:US
Mailing Address - Phone:757-710-9330
Mailing Address - Fax:
Practice Address - Street 1:3920 BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1107
Practice Address - Country:US
Practice Address - Phone:757-983-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist