Provider Demographics
NPI:1275240533
Name:ROMINE, ANGELA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ROMINE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 E SUNSHINE ST STE 707
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1333
Mailing Address - Country:US
Mailing Address - Phone:417-719-5049
Mailing Address - Fax:
Practice Address - Street 1:1736 E SUNSHINE ST STE 707
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1333
Practice Address - Country:US
Practice Address - Phone:417-719-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012013868225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist