Provider Demographics
NPI:1295306892
Name:MACKAY, ANGELA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MACKAY
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 1:9265 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1127
Mailing Address - Country:US
Mailing Address - Phone:440-773-4843
Mailing Address - Fax:
Practice Address - Street 1:1645 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-5097
Practice Address - Country:US
Practice Address - Phone:814-875-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017760225100000X
PAPT029575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist