Provider Demographics
NPI:1710859947
Name:LOUIS, ANGIE J (PT)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:J
Last Name:LOUIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 LANING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1603
Mailing Address - Country:US
Mailing Address - Phone:203-441-4261
Mailing Address - Fax:860-736-5013
Practice Address - Street 1:166 WATERBURY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1200
Practice Address - Country:US
Practice Address - Phone:203-805-4795
Practice Address - Fax:203-805-4971
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist