Provider Demographics
NPI:1366657546
Name:DECAO, ANGELA MARIE (PT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:DECAO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15042 GALAPAGOS PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5802
Mailing Address - Country:US
Mailing Address - Phone:703-583-8834
Mailing Address - Fax:
Practice Address - Street 1:12185 CLIPPER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2236
Practice Address - Country:US
Practice Address - Phone:703-496-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist