Healthcare Provider Details

I. General information

NPI: 1861087009
Provider Name (Legal Business Name): ANGELA DAWN HEATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S 1990 E APT 425
ST GEORGE UT
84790-5081
US

IV. Provider business mailing address

514 S 1990 E APT 425
ST GEORGE UT
84790-5081
US

V. Phone/Fax

Practice location:
  • Phone: 252-290-2050
  • Fax:
Mailing address:
  • Phone: 252-290-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10145
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: