{
"Npi": {
"NPI": "1801468632",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DEMEO",
"FirstName": "ANGELIQUE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DPT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LAKATOS",
"OtherFirstName": "ANGELIQUE",
"OtherMiddleName": null,
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "DPT",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "357 WINDIGROVE DR APT 811",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WAYNESBORO",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22980-7494",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-689-4677",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1102 ROSE HILL DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHARLOTTESVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22903-5128",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "434-979-8628",
"PracticeLocationAddressFaxNumber": "434-979-8536",
"EnumerationDate": "07/12/2021",
"LastUpdateDate": "04/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "2305214573",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}