Provider Demographics
NPI:1164942785
Name:GOWDY, ANGELA VICTORIA (LMP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:VICTORIA
Last Name:GOWDY
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 1:5015 TACOMA MALL BLVD STE E102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7107
Mailing Address - Country:US
Mailing Address - Phone:253-472-4400
Mailing Address - Fax:253-472-1782
Practice Address - Street 1:5015 TACOMA MALL BLVD STE E102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7107
Practice Address - Country:US
Practice Address - Phone:253-472-4400
Practice Address - Fax:253-472-1782
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2017-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60723902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist