Provider Demographics
NPI:1811147077
Name:DICKINSON-PANNONE, ANGIE CHANTEL (PT)
Entity type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:CHANTEL
Last Name:DICKINSON-PANNONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7 WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-3148
Mailing Address - Country:US
Mailing Address - Phone:551-427-9862
Mailing Address - Fax:973-427-5227
Practice Address - Street 1:7 WALNUT CT
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-3148
Practice Address - Country:US
Practice Address - Phone:551-427-9862
Practice Address - Fax:973-427-5227
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA008631002251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist