Provider Demographics
NPI:1205994571
Name:DIMAGGIO, ANGELO (PT DIP MDT)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:DIMAGGIO
Suffix:
Gender:M
Credentials:PT DIP MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 SOUTH ROCHESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-601-9207
Mailing Address - Fax:248-650-8670
Practice Address - Street 1:878 SOUTH ROCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-601-9207
Practice Address - Fax:248-650-8670
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F358200OtherBCBSM
0M78170Medicare ID - Type Unspecified