Healthcare Provider Details

I. General information

NPI: 1982375978
Provider Name (Legal Business Name): ANGEL LEA HUFFMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 3RD ST STE 8
ELKINS WV
26241-3831
US

IV. Provider business mailing address

108 3RD ST STE 8
ELKINS WV
26241-3831
US

V. Phone/Fax

Practice location:
  • Phone: 304-621-7747
  • Fax: 304-637-4588
Mailing address:
  • Phone: 304-621-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2019-3723
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: