Provider Demographics
NPI:1811004310
Name:ANGULO, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ANGULO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8114 S TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1738
Mailing Address - Country:US
Mailing Address - Phone:480-491-5571
Mailing Address - Fax:
Practice Address - Street 1:1910 E SOUTHERN AVE
Practice Address - Street 2:STE A
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7592
Practice Address - Country:US
Practice Address - Phone:480-730-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4207OtherLICENSE #