Provider Demographics
NPI:1992984884
Name:TAIBBI, ANGIE RENEE (DPT, ATC)
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:RENEE
Last Name:TAIBBI
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 BURLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-6093
Mailing Address - Country:US
Mailing Address - Phone:971-237-9469
Mailing Address - Fax:
Practice Address - Street 1:1667 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5147
Practice Address - Country:US
Practice Address - Phone:480-262-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist