Provider Demographics
NPI:1750601522
Name:GARRETT, ANGELICA LEIGH (PT)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:LEIGH
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:LEIGH
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:223 LEGACY LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1635
Mailing Address - Country:US
Mailing Address - Phone:317-331-8459
Mailing Address - Fax:
Practice Address - Street 1:10601 N MERIDIAN ST
Practice Address - Street 2:STE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1152
Practice Address - Country:US
Practice Address - Phone:317-575-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008749A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist