Provider Demographics
NPI:1306039250
Name:SZUMOWSKI, ANGELA (ATC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SZUMOWSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 WEST BROADWAY AVE.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-533-0541
Mailing Address - Fax:763-533-1052
Practice Address - Street 1:4080 W BROADWAY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5604
Practice Address - Country:US
Practice Address - Phone:763-533-0541
Practice Address - Fax:763-533-1052
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist