MEDICARE: ADELE DE ANGELIS MSPT

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	17778	MA

General Provider Information

NPI Number	:	1942377783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELE DE ANGELIS MSPT

Provider Business Mailing Address
First Line	:	117 LAKE ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-1632
Country	:	US
Telephone Number	:	617-697-8401
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 LAKE ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-1632
Country	:	US
Telephone Number	:	617-697-8401
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	01/11/2022

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