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General NPI Number Information
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NPI Number | 1306204540
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Entity Type | Individual
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Provider Name | ANGELA YOUNG CMT, MMP
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Gender | Female
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 711 E WALNUT ST SUITE 404
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City | PASADENA
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State | CA
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Zip | 91101-1676
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Country | US
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Telephone | 626-316-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 WESLEY AVE
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City | PASADENA
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State | CA
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Zip | 91104-3157
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Country | US
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Telephone | 626-316-0016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 41871
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License Number State | CA
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