Provider Demographics
NPI:1740391879
Name:ANGELO, DAVID LOUIS (MPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LOUIS
Last Name:ANGELO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3902
Mailing Address - Country:US
Mailing Address - Phone:724-463-7478
Mailing Address - Fax:724-463-0931
Practice Address - Street 1:110 BESSEMER RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-9130
Practice Address - Country:US
Practice Address - Phone:724-542-9702
Practice Address - Fax:724-542-9704
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007996L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3825787OtherAETNA - HMO
PA00692758OtherHIGHMARK BLUE SHIELD
PA116941OtherHEATLH AMER/HEALTH ASSUR.
PA5408704OtherAETNA - PPO
PA5408704OtherAETNA - PPO