Provider Demographics
NPI:1376769190
Name:BALSAMO, ANGELO JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:JOHN
Last Name:BALSAMO
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 1:119 STORRS AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4022
Mailing Address - Country:US
Mailing Address - Phone:508-843-3866
Mailing Address - Fax:
Practice Address - Street 1:965 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1614
Practice Address - Country:US
Practice Address - Phone:617-333-8408
Practice Address - Fax:781-924-3849
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist