Provider Demographics
NPI:1396726386
Name:CONSTANTINO, M ANGELA (DPT)
Entity type:Individual
Prefix:
First Name:M
Middle Name:ANGELA
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ANGELA
Other - Last Name:QUADRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19510 VENTURA BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2969
Mailing Address - Country:US
Mailing Address - Phone:818-996-1725
Mailing Address - Fax:818-996-0210
Practice Address - Street 1:19510 VENTURA BLVD
Practice Address - Street 2:STE 106
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2969
Practice Address - Country:US
Practice Address - Phone:818-996-1725
Practice Address - Fax:818-996-0210
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT27457AMedicare ID - Type Unspecified