Healthcare Provider Details

I. General information

NPI: 1730003187
Provider Name (Legal Business Name): KIMBERLY DEANGELIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 N BROAD ST STE 125
LANSDALE PA
19446-1063
US

IV. Provider business mailing address

2031 N BROAD ST STE 125
LANSDALE PA
19446-1063
US

V. Phone/Fax

Practice location:
  • Phone: 215-368-7771
  • Fax:
Mailing address:
  • Phone: 215-368-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG015999
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: