Provider Demographics
NPI:1083887517
Name:RALPH, ANGIE MAREA (LMP)
Entity Type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:MAREA
Last Name:RALPH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29434 322ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:RAVENSDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98051-9691
Mailing Address - Country:US
Mailing Address - Phone:206-851-9794
Mailing Address - Fax:
Practice Address - Street 1:29434 322ND AVE SE
Practice Address - Street 2:
Practice Address - City:RAVENSDALE
Practice Address - State:WA
Practice Address - Zip Code:98051-9691
Practice Address - Country:US
Practice Address - Phone:206-851-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist