MEDICARE: MRS. ANGELA MICHELLE HOLDER LMT

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	225700000X	Massage Therapist	12625	TN

General Provider Information

NPI Number	:	1053987107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MICHELLE HOLDER LMT

Provider Business Mailing Address
First Line	:	711 NEW HIGHWAY 68 STE C
Second Line	:
City	:	SWEETWATER
State	:	TN
Zip	:	37874-1926
Country	:	US
Telephone Number	:	423-596-5504
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 NEW HIGHWAY 68 STE C
Second Line	:
City	:	SWEETWATER
State	:	TN
Zip	:	37874-1926
Country	:	US
Telephone Number	:	423-596-5504
Fax Number	:

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

Provider Enumeration Date	:	05/30/2021
Last Update Date	:	05/30/2021

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