Provider Demographics
NPI:1376700526
Name:D'ANGELO, LAURA ANN (PT, MS, NCS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:PT, MS, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 STETSON CIR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-1028
Mailing Address - Country:US
Mailing Address - Phone:413-563-6916
Mailing Address - Fax:
Practice Address - Street 1:79 CAT MOUSAM RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6924
Practice Address - Country:US
Practice Address - Phone:413-563-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1228225100000X
MA165372251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist