Provider Demographics
NPI:1972489300
Name:DOUGLASS, ANNA MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9207
Mailing Address - Country:US
Mailing Address - Phone:260-431-3487
Mailing Address - Fax:
Practice Address - Street 1:416 E MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2015
Practice Address - Country:US
Practice Address - Phone:260-667-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015698A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist