Provider Demographics
NPI:1841298197
Name:ANGEL, ASHLIE A (MPT)
Entity type:Individual
Prefix:MRS
First Name:ASHLIE
Middle Name:A
Last Name:ANGEL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1485 FLORIDA RD
Mailing Address - Street 2:SUITE C206
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6881
Mailing Address - Country:US
Mailing Address - Phone:970-247-9415
Mailing Address - Fax:970-247-9714
Practice Address - Street 1:1485 FLORIDA RD
Practice Address - Street 2:SUITE C206
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6881
Practice Address - Country:US
Practice Address - Phone:970-247-9415
Practice Address - Fax:970-247-9714
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0007674225100000X
CO76742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46929282Medicaid
CO46929282Medicaid