Provider Demographics
NPI:1639930175
Name:TEVES, ANGEL (PT)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:TEVES
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 1:4907 W FLAGSTAFF AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8242
Mailing Address - Country:US
Mailing Address - Phone:559-624-9868
Mailing Address - Fax:
Practice Address - Street 1:4907 W FLAGSTAFF AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8242
Practice Address - Country:US
Practice Address - Phone:559-624-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty