Provider Demographics
NPI:1760640569
Name:PAPPAS, ANGELO GREGORY (PT)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:GREGORY
Last Name:PAPPAS
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 1:2227 N RICKE LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7183
Mailing Address - Country:US
Mailing Address - Phone:928-699-3329
Mailing Address - Fax:866-402-3188
Practice Address - Street 1:2227 N RICKE LN
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7183
Practice Address - Country:US
Practice Address - Phone:928-699-3329
Practice Address - Fax:866-402-3188
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist