Provider Demographics
NPI:1093062770
Name:POMPEO, ANGELO A (DPT)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:A
Last Name:POMPEO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 WEIMER RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6397
Mailing Address - Country:US
Mailing Address - Phone:575-737-0304
Mailing Address - Fax:575-737-0383
Practice Address - Street 1:1398 WEIMER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6397
Practice Address - Country:US
Practice Address - Phone:575-737-0304
Practice Address - Fax:575-737-0383
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM433833386Medicaid