Provider Demographics
NPI:1932748019
Name:DEANGELO, SALVATORE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:DEANGELO
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 1:6338 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-7432
Mailing Address - Country:US
Mailing Address - Phone:315-794-8225
Mailing Address - Fax:
Practice Address - Street 1:107 E CHESTNUT ST STE 104
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2834
Practice Address - Country:US
Practice Address - Phone:315-337-7952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist