Provider Demographics
NPI:1932382561
Name:STANLEY, ANGELA LOUISE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LOUISE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22696 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-6249
Mailing Address - Country:US
Mailing Address - Phone:712-527-5073
Mailing Address - Fax:
Practice Address - Street 1:22696 GLENVIEW AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-6249
Practice Address - Country:US
Practice Address - Phone:712-527-5073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist