Provider Demographics
NPI:1679980270
Name:MARANUK, ANGELA PEARL (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:PEARL
Last Name:MARANUK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:PEARL
Other - Last Name:BOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:370 WHITESTONE COR
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7193
Mailing Address - Country:US
Mailing Address - Phone:570-476-1500
Mailing Address - Fax:
Practice Address - Street 1:370 WHITESTONE COR
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7193
Practice Address - Country:US
Practice Address - Phone:570-476-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003444225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant