Provider Demographics
NPI:1144366584
Name:BROOKS, ANGELA FOWLER (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:FOWLER
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13939 KIMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-4773
Mailing Address - Country:US
Mailing Address - Phone:225-315-2413
Mailing Address - Fax:225-751-2115
Practice Address - Street 1:13939 KIMBLETON AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-4773
Practice Address - Country:US
Practice Address - Phone:225-315-2413
Practice Address - Fax:225-751-2115
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1327191Medicaid