Provider Demographics
NPI:1245503713
Name:ANGELO, MICHELE (MSPT)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:ANGELO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-5351
Mailing Address - Country:US
Mailing Address - Phone:732-606-7146
Mailing Address - Fax:
Practice Address - Street 1:353 N 10TH ST
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NJ
Practice Address - Zip Code:08008-5351
Practice Address - Country:US
Practice Address - Phone:732-606-7146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00963700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist