Healthcare Provider Details

I. General information

NPI: 1679400261
Provider Name (Legal Business Name): ANDREW JOSEPH ANGELO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4656 N HIGHWAY 7 STE M
HOT SPRINGS VILLAGE AR
71909-9482
US

IV. Provider business mailing address

244 PEREGRINE WAY
BOSSIER CITY LA
71112-2556
US

V. Phone/Fax

Practice location:
  • Phone: 501-984-5575
  • Fax:
Mailing address:
  • Phone: 318-773-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: