Provider Demographics
NPI:1710925425
Name:SAKELARIS, ANGELO G (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:G
Last Name:SAKELARIS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:6178 CARRIAGE HOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-7343
Mailing Address - Country:US
Mailing Address - Phone:775-826-2521
Mailing Address - Fax:775-826-2521
Practice Address - Street 1:6178 CARRIAGE HOUSE WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519
Practice Address - Country:US
Practice Address - Phone:775-826-2521
Practice Address - Fax:775-826-2521
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004716904Medicaid