Provider Demographics
NPI:1629086764
Name:LIND, ANGIELA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:ANGIELA
Middle Name:
Last Name:LIND
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 1:635 ANDERSON CIR
Mailing Address - Street 2:APT. 310
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-7761
Mailing Address - Country:US
Mailing Address - Phone:786-290-7055
Mailing Address - Fax:
Practice Address - Street 1:635 ANDERSON CIR
Practice Address - Street 2:APT. 310
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-7761
Practice Address - Country:US
Practice Address - Phone:786-290-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45645225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA45645OtherSTATE LICENSE