Provider Demographics
NPI:1578830618
Name:MCCONAUGHEY, ANGEL REBECCA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:REBECCA
Last Name:MCCONAUGHEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17004-8906
Mailing Address - Country:US
Mailing Address - Phone:717-935-2735
Mailing Address - Fax:
Practice Address - Street 1:48 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17004-8906
Practice Address - Country:US
Practice Address - Phone:717-935-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003598225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist