Provider Demographics
NPI:1205068517
Name:HANNULA, ANGELA D (DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:HANNULA
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:PO BOX 40000
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-7520
Mailing Address - Country:US
Mailing Address - Phone:970-476-2451
Mailing Address - Fax:
Practice Address - Street 1:200 ROBINSON ST STE D300
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8464
Practice Address - Country:US
Practice Address - Phone:970-718-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL10444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO775826OtherUNITEDE HEALTH
CO12249751OtherCAQH
COAAA0061Medicare Oscar/Certification