Provider Demographics
NPI:1881933943
Name:ANGELES, ALEXANDER CUTIA (RPT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:CUTIA
Last Name:ANGELES
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52249 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4573
Mailing Address - Country:US
Mailing Address - Phone:586-716-7683
Mailing Address - Fax:
Practice Address - Street 1:52249 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4573
Practice Address - Country:US
Practice Address - Phone:586-716-7683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist