Provider Demographics
NPI:1295055333
Name:ROSE, ANGELA SUNSHINE (LMT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SUNSHINE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:R
Other - Last Name:DE ROOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:907 NEIL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-8773
Mailing Address - Country:US
Mailing Address - Phone:503-869-6812
Mailing Address - Fax:877-775-2569
Practice Address - Street 1:545 LIT WAY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2401
Practice Address - Country:US
Practice Address - Phone:503-869-6812
Practice Address - Fax:877-775-2569
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14883225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist