Most Relevant Information
Provider Data
| NPI Number: | 1003832379 |
| Provider Name: | ANGELA MARIE DAVAULT OT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/13/2006 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
400 S KENNEDY DR
BRADLEY
IL
609152682
Practice Location Phone/Fax
| Phone: | 8159288051 |
| Fax: |
Provider Mailing Location
1 JANEESE CT
MANTENO
IL
609501630
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |