Provider Demographics
NPI:1245743434
Name:SABATTUS, ANGELA S (MT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:SABATTUS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:S
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:ME
Mailing Address - Zip Code:04668-0097
Mailing Address - Country:US
Mailing Address - Phone:207-796-2321
Mailing Address - Fax:207-796-2422
Practice Address - Street 1:401 PETER DANA POINT ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:ME
Practice Address - Zip Code:04668-0097
Practice Address - Country:US
Practice Address - Phone:207-796-2321
Practice Address - Fax:207-796-2422
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT3500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT3500OtherSTATE LICENSE