Provider Demographics
NPI:1013075639
Name:ANGELOS, MARIANNE (PT)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:ANGELOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 CORPORATE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-7617
Mailing Address - Country:US
Mailing Address - Phone:630-898-2200
Mailing Address - Fax:630-898-5555
Practice Address - Street 1:1245 CORPORATE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-7617
Practice Address - Country:US
Practice Address - Phone:630-898-2200
Practice Address - Fax:630-898-5555
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist