Individual
TEAIRA FAITHANGEL VANGAALEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8811 N 51ST AVE STE 102, GLENDALE, AZ 85302-4949
(623) 915-2726
Mailing address
3050 N LITCHFIELD RD STE 100, GOODYEAR, AZ 85395-7805
(602) 588-0320
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
13842
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013842
LICENSE
AZ
Enumeration date
10/29/2018
Last updated
10/29/2018
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