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General NPI Number Information
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NPI Number | 1992129662
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Entity Type | Individual
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Provider Name | ANGELA MOORE B.A., R.M.T
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Gender | Female
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Dates
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Enumeration Date | 02/14/2014
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 422 4TH ST
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City | ALAMOSA
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State | CO
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Zip | 81101-2673
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Country | US
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Telephone | 608-698-0543
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Fax |
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Provider Business Mailing Address
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Address Line | 8280 CANON CITY RD
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City | BLANCA
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State | CO
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Zip | 81123-9126
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Country | US
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Telephone | 608-698-0543
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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 | 0015115
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 4268-146
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License Number State | WI
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