Provider Demographics
NPI:1902390487
Name:MIDDLETON-BELOT, ANGEL D (LMT)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:D
Last Name:MIDDLETON-BELOT
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 1:5415 FAIRTIDE DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-7946
Mailing Address - Country:US
Mailing Address - Phone:281-515-1226
Mailing Address - Fax:
Practice Address - Street 1:5415 FAIRTIDE DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-7946
Practice Address - Country:US
Practice Address - Phone:281-515-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121763225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist