Provider Demographics
NPI:1063412914
Name:MCGILVREY, ANGELA CAROL (PT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CAROL
Last Name:MCGILVREY
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 1:9099 RED CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9670
Mailing Address - Country:US
Mailing Address - Phone:708-670-5610
Mailing Address - Fax:
Practice Address - Street 1:15751 SAN CARLOS BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3314
Practice Address - Country:US
Practice Address - Phone:708-670-5610
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist