Provider Demographics
NPI:1912210436
Name:MAGES, ANGIE MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:MARIE
Last Name:MAGES
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:PO BOX 2229
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34284-2229
Mailing Address - Country:US
Mailing Address - Phone:941-822-5007
Mailing Address - Fax:
Practice Address - Street 1:209 HARBOR DR S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2216
Practice Address - Country:US
Practice Address - Phone:941-822-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53874225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist