MEDICARE: JENNETH ANGELES

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	28832	FL

General Provider Information

NPI Number	:	1740469097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNETH ANGELES

Provider Business Mailing Address
First Line	:	3420 S SAN MATEO DR
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8215
Country	:	US
Telephone Number	:	845-866-2045
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 S SAN MATEO DR
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8215
Country	:	US
Telephone Number	:	845-866-2045
Fax Number	:

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

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	02/12/2025

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Directions to “ JENNETH ANGELES ” Practice Location

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