Provider Demographics
NPI:1073775292
Name:MAGIN, ANGELA MARIE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:MAGIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:MADALENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2300 BUFFALO RD
Mailing Address - Street 2:BUILDING 400
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1360
Mailing Address - Country:US
Mailing Address - Phone:585-369-6342
Mailing Address - Fax:
Practice Address - Street 1:2300 BUFFALO RD
Practice Address - Street 2:BUILDING 400
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1360
Practice Address - Country:US
Practice Address - Phone:585-369-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018818-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02399113Medicaid
NY02399113Medicaid