Healthcare Provider Details

I. General information

NPI: 1265796460
Provider Name (Legal Business Name): EMILY KASHE DEANGELIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 PIONEER BLVD SUITE 270
ARTESIA CA
90701-2776
US

IV. Provider business mailing address

17100 PIONEER BLVD SUITE 270
ARTESIA CA
90701-2776
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-4900
  • Fax: 562-865-4945
Mailing address:
  • Phone: 562-865-4900
  • Fax: 562-865-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 16111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: