Provider Demographics
NPI:1912155656
Name:DOUGLAS, ANGELA LAUREN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LAUREN
Last Name:DOUGLAS
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 1:5290 E YALE CIR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6918
Mailing Address - Country:US
Mailing Address - Phone:303-756-6059
Mailing Address - Fax:
Practice Address - Street 1:5290 E YALE CIR
Practice Address - Street 2:SUITE 207
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6918
Practice Address - Country:US
Practice Address - Phone:303-756-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist