Provider Demographics
NPI:1205242211
Name:SCHMIDT, ANGELA (LMT, MMP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 GLENLOCK DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2309
Mailing Address - Country:US
Mailing Address - Phone:407-739-8664
Mailing Address - Fax:
Practice Address - Street 1:2130 GLENLOCK DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-2309
Practice Address - Country:US
Practice Address - Phone:407-739-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL48079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist