Provider Demographics
NPI:1184058877
Name:CHUNG, ANGELA RENEE (DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TUMWATER BLVD SE STE 113
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6422
Mailing Address - Country:US
Mailing Address - Phone:360-704-7276
Mailing Address - Fax:360-704-7277
Practice Address - Street 1:2964 LIMITED LN NW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4577
Practice Address - Country:US
Practice Address - Phone:360-704-7276
Practice Address - Fax:360-704-7277
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60369827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01400786OtherMEDICARE RAILROAD
WA1184058877Medicaid
WA0314971OtherDEPT. OF LABOR AND INDUSTRIES
WA0314971OtherDEPT. OF LABOR AND INDUSTRIES