Provider Demographics
NPI:1891432480
Name:MYLES, ANGELA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MYLES
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:MYLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:23592 WINDSONG APT 19F
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2340
Mailing Address - Country:US
Mailing Address - Phone:631-235-4034
Mailing Address - Fax:631-716-7778
Practice Address - Street 1:23592 WINDSONG APT 19F
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2340
Practice Address - Country:US
Practice Address - Phone:631-235-4034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty