MEDICARE: MR. MICHAEL ANGEL VALDELLON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	044282	NY

General Provider Information

NPI Number	:	1144595133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANGEL VALDELLON PT

Provider Business Mailing Address
First Line	:	8635 QUEENS BLVD
Second Line	:	APT. 3E
City	:	ELMHURST
State	:	NY
Zip	:	11373-4434
Country	:	US
Telephone Number	:	718-766-9875
Fax Number	:

Provider Business Practice Location Address
First Line	:	9801 159TH AVE
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3543
Country	:	US
Telephone Number	:	718-843-4880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	03/09/2012

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