Provider Demographics
NPI:1770360547
Name:HALL, ANGELA PATRICE (LMT, CNMT, CPT)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:PATRICE
Last Name:HALL
Suffix:
Gender:F
Credentials:LMT, CNMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 NORTHPARK DR STE 209
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4238
Mailing Address - Country:US
Mailing Address - Phone:855-487-8434
Mailing Address - Fax:
Practice Address - Street 1:4465 NORTHPARK DR STE 209
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4238
Practice Address - Country:US
Practice Address - Phone:855-487-8434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0025240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist