Provider Demographics
NPI:1720496615
Name:HEARY, ANGELA (LMT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HEARY
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 1:2809 BOSTON ST APT 114
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4815
Mailing Address - Country:US
Mailing Address - Phone:407-373-4157
Mailing Address - Fax:
Practice Address - Street 1:103 CHESAPEAKE PARK PLZ
Practice Address - Street 2:GE MRAS EMPLOYEE HEALTH & WELLNESS CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-4201
Practice Address - Country:US
Practice Address - Phone:410-682-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist