Provider Demographics
NPI:1871571422
Name:HENDERSHOT, ANGELA M (MPT)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
Last Name:HENDERSHOT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 CHEAT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4451
Mailing Address - Country:US
Mailing Address - Phone:304-594-2500
Mailing Address - Fax:305-594-9310
Practice Address - Street 1:2195 CHEAT ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508
Practice Address - Country:US
Practice Address - Phone:304-594-2500
Practice Address - Fax:302-594-9310
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV02353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002408Medicaid
WV3810002408Medicaid