Provider Demographics
NPI:1912903394
Name:WUEBBELS, ANGELA D (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:WUEBBELS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:916 TALON DR
Mailing Address - Street 2:STE 102
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1848
Mailing Address - Country:US
Mailing Address - Phone:618-628-8211
Mailing Address - Fax:618-628-0883
Practice Address - Street 1:12 WOLF CREEK DR
Practice Address - Street 2:STE 200
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2343
Practice Address - Country:US
Practice Address - Phone:618-239-9910
Practice Address - Fax:618-239-9795
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00110675OtherMEDICARE RAILROAD
IL7894268OtherAETNA
IL08220357OtherBCBS GRP#
IL7894268OtherAETNA