Provider Demographics
NPI:1457373904
Name:ANGER, MARIE ANN (DPTSC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ANN
Last Name:ANGER
Suffix:
Gender:F
Credentials:DPTSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25787 KELLOGG ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3920
Mailing Address - Country:US
Mailing Address - Phone:909-557-0578
Mailing Address - Fax:909-989-6158
Practice Address - Street 1:3200 INLAND EMPIRE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5513
Practice Address - Country:US
Practice Address - Phone:909-945-3580
Practice Address - Fax:909-989-6158
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT217140Medicare ID - Type UnspecifiedPHYSICAL THERAPY