Provider Demographics
NPI:1043855448
Name:BAKHOUM, ANGEL YOUSSEF (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:YOUSSEF
Last Name:BAKHOUM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 67TH PL APT 1L
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7008
Mailing Address - Country:US
Mailing Address - Phone:646-384-1917
Mailing Address - Fax:
Practice Address - Street 1:75 N HANGAR RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11430-1826
Practice Address - Country:US
Practice Address - Phone:718-656-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039954-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist