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General NPI Number Information
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NPI Number | 1851672281
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Entity Type | Individual
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Provider Name | ANGELA MARGARET BLACK L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 2120 26TH ST W STE 101
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City | WILLISTON
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State | ND
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Zip | 58801-2495
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Country | US
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Telephone | 850-819-9769
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 26TH ST W
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City | WILLISTON
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State | ND
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Zip | 58801-2496
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Country | US
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Telephone | 850-819-9769
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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 | MA48397
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License Number State | FL
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