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General NPI Number Information
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NPI Number | 1710753793
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Entity Type | Individual
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Provider Name | ANGELA BOSTICK-CAMPBELL LMT
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Gender | Female
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Dates
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Enumeration Date | 11/30/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 195A KEITH ST
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City | WARRENTON
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State | VA
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Zip | 20186-3231
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Country | US
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Telephone | 571-375-8748
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Fax |
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Provider Business Mailing Address
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Address Line | 195A KEITH ST
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City | WARRENTON
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State | VA
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Zip | 20186-3231
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Country | US
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Telephone | 571-375-8748
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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 | 0019010048
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License Number State |
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