Provider Demographics
NPI:1962145177
Name:PLACEK, ANGELICA DENISE
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:DENISE
Last Name:PLACEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 RIDGELY
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-1114
Mailing Address - Country:US
Mailing Address - Phone:760-898-5131
Mailing Address - Fax:
Practice Address - Street 1:3617 RIDGELY
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-1114
Practice Address - Country:US
Practice Address - Phone:760-898-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer