Provider Demographics
NPI:1063992089
Name:BARKER, ANGELA FAYE (LMT, BCTMB)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:FAYE
Last Name:BARKER
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 SHAWNEE EST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-9710
Mailing Address - Country:US
Mailing Address - Phone:304-633-5021
Mailing Address - Fax:
Practice Address - Street 1:1208 TRENOL HTS STE 4
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-5600
Practice Address - Country:US
Practice Address - Phone:304-633-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2005-1829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist