MEDICARE: ANDREW JOSEPH ANGELO DPT

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

General Provider Information

NPI Number	:	1679400261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW JOSEPH ANGELO DPT

Provider Business Mailing Address
First Line	:	244 PEREGRINE WAY
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-2556
Country	:	US
Telephone Number	:	318-773-4056
Fax Number	:

Provider Business Practice Location Address
First Line	:	4656 N HIGHWAY 7 STE M
Second Line	:
City	:	HOT SPRINGS VILLAGE
State	:	AR
Zip	:	71909-9482
Country	:	US
Telephone Number	:	501-984-5575
Fax Number	:

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

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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