Individual
MISS ANGELA MARIE GILILLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
519 REVIS ST, BENTON, AR 72015-4648
(479) 495-0651
(479) 495-2622
Mailing address
519 REVIS ST, BENTON, AR 72015-4648
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA2362
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA2362
STATE LIC
AR
Enumeration date
12/07/2011
Last updated
12/07/2011
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