Provider Demographics
NPI:1205438850
Name:DE ANGELIS, MICHEL ADAM (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:ADAM
Last Name:DE ANGELIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 MONTROSE AVE APT 15
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1345
Mailing Address - Country:US
Mailing Address - Phone:818-314-0808
Mailing Address - Fax:
Practice Address - Street 1:2001 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2932
Practice Address - Country:US
Practice Address - Phone:818-953-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty