Provider Demographics
NPI:1760528756
Name:PAGANO, ANGELA RENEE (PT)
Entity Type:Individual
Prefix:MR
First Name:ANGELA
Middle Name:RENEE
Last Name:PAGANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4140 OLD MILL PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6550
Mailing Address - Country:US
Mailing Address - Phone:636-926-2700
Mailing Address - Fax:636-447-4919
Practice Address - Street 1:4140 OLD MILL PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6550
Practice Address - Country:US
Practice Address - Phone:636-926-2700
Practice Address - Fax:636-447-4919
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19991391952251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics