Basic Information
| Provider Information | |||||||||
| NPI: | 1376872085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARKGRAF | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | CELESTE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 SHADOW LN | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930657380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184044837 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26560 AGOURA RD STE 110B | ||||||||
| Address2: | |||||||||
| City: | CALABASAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913023530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188801260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2009 | ||||||||
| LastUpdateDate: | 12/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT27953 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251P0200X | PT27953 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.