Provider Demographics
NPI:1952029902
Name:TRAMMELL, ANGELICA (LMT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:TRAMMELL
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:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-0863
Mailing Address - Country:US
Mailing Address - Phone:334-338-0942
Mailing Address - Fax:
Practice Address - Street 1:126 CENTERWAY DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:AL
Practice Address - Zip Code:36274-1758
Practice Address - Country:US
Practice Address - Phone:334-338-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5684225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist