Provider Demographics
NPI:1710501176
Name:HONACKIE, ANGELA D (LMT, RYT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:HONACKIE
Suffix:
Gender:F
Credentials:LMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5564 LITTLE DEBBIE PKWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37363
Mailing Address - Country:US
Mailing Address - Phone:423-498-3400
Mailing Address - Fax:423-498-3401
Practice Address - Street 1:5564 LITTLE DEBBIE PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:COLLEGEDALE
Practice Address - State:TN
Practice Address - Zip Code:37363
Practice Address - Country:US
Practice Address - Phone:423-498-3400
Practice Address - Fax:423-498-3401
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000013215225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist