Provider Demographics
NPI:1245564269
Name:MAE, ANGELA (CMT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:MAE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4446 CEDAR LAKE RD
Mailing Address - Street 2:#2
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:952-920-1222
Mailing Address - Fax:
Practice Address - Street 1:4455 NORTH HIGHWAY 169 SUITE 200
Practice Address - Street 2:FOUR SEASONS FAMILY CHIROPRACTIC CLINIC
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442
Practice Address - Country:US
Practice Address - Phone:763-557-9032
Practice Address - Fax:763-557-9838
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist