Individual
ANGELA FANELLA EBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3200 NORTHLINE AVE, STE 160, GREENSBORO, NC 27408-7616
(336) 545-5000
(336) 545-5020
Mailing address
PO BOX 38008, GREENSBORO, NC 27438-8008
(336) 545-5000
(336) 545-5020
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9714
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079UA
BCBS
NC
01
—
198206
MEDCOST
NC
01
—
250087A
MEDICARE PTAN
NC
05
—
7212246
—
NC
01
—
P00401782
MEDICARE RAILROAD
NC
Enumeration date
04/10/2006
Last updated
09/09/2022
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