Provider Demographics
NPI:1063734481
Name:BEHREND, ANGELA (RM/T CNMT LMT MECP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BEHREND
Suffix:
Gender:F
Credentials:RM/T CNMT LMT MECP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 DAYBREAK CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-2639
Mailing Address - Country:US
Mailing Address - Phone:719-651-3874
Mailing Address - Fax:
Practice Address - Street 1:2150 HOLLOW BROOK DR STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8415
Practice Address - Country:US
Practice Address - Phone:719-651-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO665225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist