Provider Demographics
NPI:1376702381
Name:CROSS, ANGELA JANE (LMP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:JANE
Last Name:CROSS
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 1:18756 ROAD 5 NW
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-9505
Mailing Address - Country:US
Mailing Address - Phone:509-289-9588
Mailing Address - Fax:
Practice Address - Street 1:306 BASIN ST NW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1628
Practice Address - Country:US
Practice Address - Phone:509-289-9588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021506172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist