Basic Information
| Provider Information | |||||||||
| NPI: | 1689652778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPPE | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | JUDGE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PHILLIPPE | ||||||||
| OtherFirstName: | ANGELA | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 119 STUART AVE | ||||||||
| Address2: | |||||||||
| City: | EMERALD ISLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285943034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527643155 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 BREWSTER BLVD | ||||||||
| Address2: | NAVAL HOSPITAL CAMP LEJEUNE | ||||||||
| City: | CAMP LEJEUNE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285472538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104504750 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305002316 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.