Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT-1228 | WY |
Y | 2251N0400X | Physical Therapist - Neurology | 16537 | MA |
NPI | 1376700526 |
---|---|
Provider Name | Laura Ann D'angelo |
First Address | Syracuse, NY 13215-1028 |
Second Address | Kennebunk, ME 04043-6924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2008 |
Last Update Date | 16/05/2008 |