Provider Demographics
NPI:1982375978
Name:HUFFMAN, ANGEL LEA (LMT)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:LEA
Last Name:HUFFMAN
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 1:108 3RD ST STE 8
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3831
Mailing Address - Country:US
Mailing Address - Phone:304-621-7747
Mailing Address - Fax:
Practice Address - Street 1:108 3RD ST STE 8
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3831
Practice Address - Country:US
Practice Address - Phone:304-621-7747
Practice Address - Fax:304-637-4588
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2019-3723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist