Provider Demographics
NPI:1679162838
Name:WATKINS, ANGELA (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 OLD BEE CAVES RD APT 425
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8284
Mailing Address - Country:US
Mailing Address - Phone:817-992-6321
Mailing Address - Fax:
Practice Address - Street 1:9301 OLD BEE CAVES RD APT 425
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8284
Practice Address - Country:US
Practice Address - Phone:817-992-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT123574225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist