Provider Demographics
NPI:1659760197
Name:OPRY, ANGELA (LMT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:OPRY
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 1:900 W DAVIS ST
Mailing Address - Street 2:SUITE 101-C
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2700
Mailing Address - Country:US
Mailing Address - Phone:281-731-8237
Mailing Address - Fax:
Practice Address - Street 1:900 W DAVIS ST
Practice Address - Street 2:SUITE 101-C
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2700
Practice Address - Country:US
Practice Address - Phone:281-731-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4644173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4644OtherLICENSED MASSAGE THERAPIST