Provider Demographics
NPI:1699759571
Name:LANDSETTLE, ANGELA RENEE (PT 010884)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:LANDSETTLE
Suffix:
Gender:F
Credentials:PT 010884
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:WARNOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT 010884
Mailing Address - Street 1:211 STOCKSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-5507
Mailing Address - Country:US
Mailing Address - Phone:937-644-3311
Mailing Address - Fax:937-644-0373
Practice Address - Street 1:211 STOCKSDALE DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-5507
Practice Address - Country:US
Practice Address - Phone:937-644-3311
Practice Address - Fax:937-644-0373
Is Sole Proprietor?:No
Enumeration Date:2005-12-03
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 010884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000372032OtherANTHEM PROVIDER NUMBER
OH31-1356625OtherGREAT WEST HEALTHCARE PRO
OH311356625030OtherCARESOURCE MCO
OH685840OtherUHC
OH9401895OtherPHCS NETWORK
OH15668OtherNATIONWIDE INSURANCE
OH23-2804807OtherREHAB PROVIDER NETWORK
OH9401895OtherPHCS NETWORK