Provider Demographics
NPI:1134901648
Name:BREEZE, ANGELIA G (LMT)
Entity type:Individual
Prefix:
First Name:ANGELIA
Middle Name:G
Last Name:BREEZE
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 1:4603 UPPER DENTON RD
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-6763
Mailing Address - Country:US
Mailing Address - Phone:817-715-9257
Mailing Address - Fax:
Practice Address - Street 1:4603 UPPER DENTON RD
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76085-6763
Practice Address - Country:US
Practice Address - Phone:817-715-9257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT110613225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty