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Individual
JOHN MARK DEANGELO
Active
Individual
JOHN MARK DEANGELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT018397
PA
2255A2300X
Athletic Trainer
RT001629A
PA
Other
Enumeration date
10/23/2006
Last updated
12/26/2008
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