MEDICARE: ANGELA ROSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	6389050-4701	UT

General Provider Information

NPI Number	:	1285326843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA ROSE

Provider Business Mailing Address
First Line	:	1100 S 2000 E APT M2003
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-6218
Country	:	US
Telephone Number	:	801-663-6109
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 N MAIN ST
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4800
Country	:	US
Telephone Number	:	801-663-6109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	06/05/2026

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Directions to “ ANGELA ROSE ” Practice Location

Language	Start Address	Practice Location

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