MEDICARE: MS. ANGELA LYNN ADKISSON

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

General Provider Information

NPI Number	:	1851150999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA LYNN ADKISSON

Provider Business Mailing Address
First Line	:	PO BOX 5211
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85123-2845
Country	:	US
Telephone Number	:	623-419-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	15640 S PATAGONIA RD
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85123-6154
Country	:	US
Telephone Number	:	623-419-8228
Fax Number	:

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

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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