Provider Demographics
NPI:1952661209
Name:ANGELA RINGWALD
Entity Type:Organization
Organization Name:ANGELA RINGWALD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RINGWALD
Authorized Official - Suffix:
Authorized Official - Credentials:BS, LMT
Authorized Official - Phone:503-320-1400
Mailing Address - Street 1:PO BOX 3104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3104
Mailing Address - Country:US
Mailing Address - Phone:503-320-1400
Mailing Address - Fax:
Practice Address - Street 1:3808 N WILLIAMS AVE
Practice Address - Street 2:SUITE F
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1467
Practice Address - Country:US
Practice Address - Phone:503-320-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty