Provider Demographics
NPI:1568189959
Name:WALKER, ANGELA GOVER
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:GOVER
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 MINSTREL WAY STE 160
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5336
Mailing Address - Country:US
Mailing Address - Phone:410-312-9922
Mailing Address - Fax:410-312-9923
Practice Address - Street 1:7130 MINSTREL WAY STE 160
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5336
Practice Address - Country:US
Practice Address - Phone:410-312-9922
Practice Address - Fax:410-312-9923
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM01198225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM01198OtherMASSAGE LICENSE