Active NPI
Angelique Witlam, PT, DPT, ATP
- Physical Therapist
- Monticello, IN
National Provider Identifier
1144589813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05005405A
- Practice address
- 906 W. Executive Court
Monticello, IN 47960 - Phone
- (574) 583-9950
- Fax
- (574) 583-9951
- NPI assigned
- May 15, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05005405A | IN | Primary |
Addresses
Primary practice location
906 W. Executive Court
Monticello, IN 47960
Mailing address
2380 S Roberts Way
Logansport, IN 46947-6626
Phone (574) 753-0466
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05005405A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337040000000",
"number": "1144589813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2380 S ROBERTS WAY",
"city": "LOGANSPORT",
"state": "IN",
"postal_code": "469476626",
"telephone_number": "574-753-0466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "906 W. EXECUTIVE COURT",
"city": "MONTICELLO",
"state": "IN",
"postal_code": "47960",
"telephone_number": "574-583-9950",
"fax_number": "574-583-9951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITLAM",
"first_name": "ANGELIQUE",
"name_prefix": "Dr.",
"credential": "PT, DPT, ATP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-15",
"last_updated": "2012-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05005405A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monticello, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.