Angela Rae Mulhollem, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

TEI002883 Issued in PA

Practice address

429 Manor Dr Ste 10
Ebensburg, PA 15931-4917

Phone

(814) 472-6060

Fax

(814) 472-1293

NPI assigned

May 10, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1871239178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 MAPLE ST",
            "city": "PORTAGE",
            "state": "PA",
            "postal_code": "159461415",
            "telephone_number": "814-341-4686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 MANOR DR STE 10",
            "city": "EBENSBURG",
            "state": "PA",
            "postal_code": "159314917",
            "telephone_number": "814-472-6060",
            "fax_number": "814-472-1293"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "903 Maple St",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "PA",
            "postal_code": "159461415",
            "country_code": "US",
            "telephone_number": "814-341-4686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULHOLLEM",
        "first_name": "ANGELA",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "PA",
            "license": "TEI002883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Netsmart",
            "affiliation": "N",
            "address_1": "429 Manor Dr Ste 10",
            "city": "Ebensburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "159314917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapy Assistant in Ebensburg, PA
• Providers in Ebensburg, PA by specialty
• Physical Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.