Provider Demographics
NPI:1043732241
Name:DIMARTINO, ANGELA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-0323
Mailing Address - Country:US
Mailing Address - Phone:517-223-8308
Mailing Address - Fax:517-223-8311
Practice Address - Street 1:7701 GRAND RIVER RD STE 100
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9396
Practice Address - Country:US
Practice Address - Phone:517-579-2839
Practice Address - Fax:517-579-2838
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist