MEDICARE: ANGEL STRONG LMBT,MMP

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	16007	NC

General Provider Information

NPI Number	:	1396497665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL STRONG LMBT,MMP

Provider Business Mailing Address
First Line	:	9612 CAYENNE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-0103
Country	:	US
Telephone Number	:	843-513-2401
Fax Number	:

Provider Business Practice Location Address
First Line	:	9612 CAYENNE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-0103
Country	:	US
Telephone Number	:	843-513-2401
Fax Number	:

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

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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