Provider Demographics
NPI:1740862317
Name:MAPLES, ANGELA RENE' (PTA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENE'
Last Name:MAPLES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 UTAH AVE SE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-8324
Mailing Address - Country:US
Mailing Address - Phone:815-980-6475
Mailing Address - Fax:
Practice Address - Street 1:5012 UTAH AVE SE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-8324
Practice Address - Country:US
Practice Address - Phone:815-980-6475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101050225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant