Provider Demographics
NPI:1265423172
Name:TATE, ANGELA ROSEMARIE (PT, PHD, CERT MDT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ROSEMARIE
Last Name:TATE
Suffix:
Gender:F
Credentials:PT, PHD, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 EASTON RD
Mailing Address - Street 2:105 CHATEAU
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2027
Mailing Address - Country:US
Mailing Address - Phone:215-659-7759
Mailing Address - Fax:215-659-6658
Practice Address - Street 1:1003 EASTON RD
Practice Address - Street 2:105 CHATEAU
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2027
Practice Address - Country:US
Practice Address - Phone:215-659-7759
Practice Address - Fax:215-659-6658
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006102L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011976290001Medicaid
PA000644553OtherBLUE CROSS BLUE SHIELD
PA2101185OtherAETNA
PA30022508OtherKEYSTONE MERCY
PA088959RB2Medicare PIN
PA088959RB2Medicare PIN