Provider Demographics
NPI:1396239695
Name:DEPAOLA, ANGELA LEE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LEE
Last Name:DEPAOLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:LEE
Other - Last Name:SERRANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 ELM ST STE 7
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3059
Mailing Address - Country:US
Mailing Address - Phone:207-571-3420
Mailing Address - Fax:
Practice Address - Street 1:380 ELM ST STE 7
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3059
Practice Address - Country:US
Practice Address - Phone:207-571-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist