Provider Demographics
NPI:1588326979
Name:VANNOSTRAND, ANGELA (DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:VANNOSTRAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6343
Mailing Address - Country:US
Mailing Address - Phone:989-971-8222
Mailing Address - Fax:989-971-8222
Practice Address - Street 1:720 LIVINGSTON ST BSMT SUITE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6392
Practice Address - Country:US
Practice Address - Phone:989-899-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501020248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty