Healthcare Provider Details

I. General information

NPI: 1568189959
Provider Name (Legal Business Name): ANGELA GOVER WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 MINSTREL WAY STE 160
COLUMBIA MD
21045-5336
US

IV. Provider business mailing address

7130 MINSTREL WAY STE 160
COLUMBIA MD
21045-5336
US

V. Phone/Fax

Practice location:
  • Phone: 410-312-9922
  • Fax: 410-312-9923
Mailing address:
  • Phone: 410-312-9922
  • Fax: 410-312-9923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM01198
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: