Provider Demographics
NPI:1265787592
Name:NEWMAN, ANGELA KAYE (LMT06)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAYE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:LMT06
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 BROOKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31098-1150
Mailing Address - Country:US
Mailing Address - Phone:478-919-3651
Mailing Address - Fax:
Practice Address - Street 1:1014 BROOKLEY AVE
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31098-1150
Practice Address - Country:US
Practice Address - Phone:478-919-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT008434225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist