Provider Demographics
NPI:1679843775
Name:ELMSHAEUSER, ANGELA K (DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:ELMSHAEUSER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:K
Other - Last Name:HARTWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2416 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1320
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:110 N WALMART DR
Practice Address - Street 2:SUITE F
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-5905
Practice Address - Country:US
Practice Address - Phone:662-779-1096
Practice Address - Fax:662-779-3949
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004865225100000X
IL070-019044225100000X
MS5855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist