Healthcare Provider Details

I. General information

NPI: 1275465833
Provider Name (Legal Business Name): ANGIE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 BOLL WEEVIL CIR STE 17
ENTERPRISE AL
36330-2749
US

IV. Provider business mailing address

7689 COUNTY ROAD 636
CHANCELLOR AL
36316-7071
US

V. Phone/Fax

Practice location:
  • Phone: 334-393-7546
  • Fax:
Mailing address:
  • Phone: 334-449-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6399
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: