Provider Demographics
NPI:1497036081
Name:BRIGHAM, ANGELA LYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYN
Last Name:BRIGHAM
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 1:5450 CONCORD BLVD APT A4
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2424
Mailing Address - Country:US
Mailing Address - Phone:925-370-4738
Mailing Address - Fax:
Practice Address - Street 1:110 CEDAR POINTE LOOP
Practice Address - Street 2:#1016
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4160
Practice Address - Country:US
Practice Address - Phone:925-787-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist