Provider Demographics
NPI:1396346441
Name:ANGELLO, JOSEPH M (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:ANGELLO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CRYSTAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-6002
Mailing Address - Country:US
Mailing Address - Phone:585-734-4105
Mailing Address - Fax:
Practice Address - Street 1:205 CRYSTAL CREEK DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-6002
Practice Address - Country:US
Practice Address - Phone:585-734-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist