Provider Demographics
NPI:1447670369
Name:ANGELES, DESEREE-JOY (RPT)
Entity type:Individual
Prefix:
First Name:DESEREE-JOY
Middle Name:
Last Name:ANGELES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5170
Mailing Address - Country:US
Mailing Address - Phone:773-934-8052
Mailing Address - Fax:
Practice Address - Street 1:1184 VISTA DR
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5170
Practice Address - Country:US
Practice Address - Phone:773-934-8052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist