Provider Demographics
NPI:1730392879
Name:BESHEARS, ANGELA MICHELLE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MICHELLE
Last Name:BESHEARS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4621 W PARK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2318
Mailing Address - Country:US
Mailing Address - Phone:972-985-1776
Mailing Address - Fax:972-985-6088
Practice Address - Street 1:4621 W PARK BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2318
Practice Address - Country:US
Practice Address - Phone:972-985-1776
Practice Address - Fax:972-985-6088
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist