Provider Demographics
NPI:1669692588
Name:ANGLE, DANNY (LPT)
Entity type:Individual
Prefix:MR
First Name:DANNY
Middle Name:
Last Name:ANGLE
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 TAR LNDG
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:NC
Mailing Address - Zip Code:28438-9064
Mailing Address - Country:US
Mailing Address - Phone:910-484-9663
Mailing Address - Fax:910-484-6668
Practice Address - Street 1:3013A RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5441
Practice Address - Country:US
Practice Address - Phone:910-484-9663
Practice Address - Fax:910-484-6668
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3216OtherSTATE LICENSE