Provider Demographics
NPI:1144595133
Name:VALDELLON, MICHAEL ANGEL (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANGEL
Last Name:VALDELLON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 QUEENS BLVD
Mailing Address - Street 2:APT. 3E
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4434
Mailing Address - Country:US
Mailing Address - Phone:718-766-9875
Mailing Address - Fax:
Practice Address - Street 1:9801 159TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3543
Practice Address - Country:US
Practice Address - Phone:718-843-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist