Individual
GENITA ANGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2448 N MERRIT CREEK LOOP, SUITE 2A, COEUR D ALENE, ID 83814-4953
(208) 664-2901
(208) 667-9266
Mailing address
2448 N MERRIT CREEK LOOP, SUITE 2A, COEUR D ALENE, ID 83814-4953
(208) 664-2901
(208) 667-9266
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-258
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010026877
REGENCE
—
01
—
0063788
WA L&I
—
01
—
100000120993
REGENCE
—
01
—
185598800
FEDERAL L&I
—
01
—
5003984
REGENCE MED ADVANTAGE
—
01
—
82 0534955
ID STATE INSURANCE FUND
—
01
—
82 053495583814A001
TRIWEST/TRICARE
—
01
—
DA3588
RAILROAD MEDICARE
—
05
—
M0026441 171096043
—
ID
01
—
QMXPR0060660
MOLINA
—
01
—
T9784
BLUE CROSS OF IDAHO
ID
01
—
TID 91051 NPI
GROUP HEALTH
—
01
—
TID NPI SSN
FIRST CHOICE
—
Enumeration date
02/15/2011
Last updated
06/23/2011
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