Provider Demographics
NPI:1093352841
Name:DAHLEN, ANGELA RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:DAHLEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:STEADHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:13011 MERIDIAN E APT H212
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-9473
Mailing Address - Country:US
Mailing Address - Phone:916-817-7772
Mailing Address - Fax:
Practice Address - Street 1:10312 120TH ST E STE 9
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2100
Practice Address - Country:US
Practice Address - Phone:253-442-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34643225700000X
WAMA.60944090225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist