Provider Demographics
NPI:1770577587
Name:REWERTS, ANGELA M (PT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:REWERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2723
Mailing Address - Country:US
Mailing Address - Phone:316-804-6087
Mailing Address - Fax:316-804-6265
Practice Address - Street 1:600 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8780
Practice Address - Country:US
Practice Address - Phone:316-804-6087
Practice Address - Fax:316-804-6265
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist