Provider Demographics
NPI:1144700345
Name:WOOTEN-HART, ANGELA LASHELL (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LASHELL
Last Name:WOOTEN-HART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 PERSIMMON TRL
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-0058
Mailing Address - Country:US
Mailing Address - Phone:318-680-8185
Mailing Address - Fax:
Practice Address - Street 1:3160 GUS THOMASSON RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4048
Practice Address - Country:US
Practice Address - Phone:469-329-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2087630225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant