Provider Demographics
NPI:1154766327
Name:DEAL, ANGELA SHANNON (PTA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SHANNON
Last Name:DEAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12124 MELODY DR APT 202
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2175
Mailing Address - Country:US
Mailing Address - Phone:970-467-0157
Mailing Address - Fax:
Practice Address - Street 1:12124 MELODY DR APT 202
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2175
Practice Address - Country:US
Practice Address - Phone:970-467-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012476225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant