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General NPI Number Information
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NPI Number | 1477896223
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Entity Type | Individual
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Provider Name | ANGELA MARINO MT
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Gender | Female
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Dates
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Enumeration Date | 03/30/2013
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Last Update Date | 03/30/2013
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Provider Practice Location Address
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Address Line | 1125 BLACKBIRD CT
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City | BURLESON
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State | TX
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Zip | 76028-0602
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Country | US
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Telephone | 817-295-2484
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Fax |
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Provider Business Mailing Address
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Address Line | 105 W ELLISON ST
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City | BURLESON
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State | TX
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Zip | 76028-4246
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Country | US
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Telephone | 817-933-8556
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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 | MT112594
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License Number State | TX
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