Provider Demographics
NPI:1871064931
Name:PHIFER, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PHIFER
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 1:651 W SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36105-3149
Mailing Address - Country:US
Mailing Address - Phone:334-652-4745
Mailing Address - Fax:
Practice Address - Street 1:ARBORETUM NURSING AND REHAB CENTER OF WINNIE
Practice Address - Street 2:1215 HIGHWAY 124
Practice Address - City:WINNIE
Practice Address - State:TX
Practice Address - Zip Code:77665
Practice Address - Country:US
Practice Address - Phone:409-296-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2143688225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant