MEDICARE: ANGELA DENISE REESE LMT, LE

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	MT011537	GA

General Provider Information

NPI Number	:	1720559693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DENISE REESE LMT, LE

Provider Business Mailing Address
First Line	:	1751 MISSELTHRUSH LN
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-3084
Country	:	US
Telephone Number	:	224-456-9886
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 PAVILION CT
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6666
Country	:	US
Telephone Number	:	224-456-9886
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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