Individual
MISS ANGELA KOULAX
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
319A SOUTHBRIDGE ST, AUBURN, MA 01501-2598
(508) 832-2628
Mailing address
319A SOUTHBRIDGE ST, AUBURN, MA 01501-2598
(508) 832-2628
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15702
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0398632
—
MA
01
—
469807
TUFTS
MA
01
—
57018
FALLON
MA
01
—
Y68023
BLUE SHIELD
MA
Enumeration date
02/03/2006
Last updated
07/08/2007
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