Provider Demographics
NPI:1689568354
Name:PAEZ, ANGELO DAVID (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:DAVID
Last Name:PAEZ
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2823
Mailing Address - Country:US
Mailing Address - Phone:919-272-4602
Mailing Address - Fax:
Practice Address - Street 1:3665 S 8400 W STE 210
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-4909
Practice Address - Country:US
Practice Address - Phone:801-250-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14224973-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist