Provider Demographics
NPI:1093457723
Name:ANGELO, KAILYN JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:KAILYN
Middle Name:JEAN
Last Name:ANGELO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 NORMA LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5659
Mailing Address - Country:US
Mailing Address - Phone:484-883-4384
Mailing Address - Fax:
Practice Address - Street 1:1700 MARKET ST STE 1005
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3920
Practice Address - Country:US
Practice Address - Phone:484-883-4384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty