Provider Demographics
NPI:1902063100
Name:REICHARDT, ANGELA M (MPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:REICHARDT
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:PO BOX 8763
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0732
Mailing Address - Country:US
Mailing Address - Phone:540-366-9244
Mailing Address - Fax:540-366-9245
Practice Address - Street 1:7226B WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4264
Practice Address - Country:US
Practice Address - Phone:540-366-9244
Practice Address - Fax:540-366-9245
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052018012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADA1361Medicare PIN
VA017448S05Medicare PIN
VAC08605Medicare PIN