Provider Demographics
NPI:1124291042
Name:HUIZINGA, ANGIE PATRICIA (LMT LIC# MA38162)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:PATRICIA
Last Name:HUIZINGA
Suffix:
Gender:F
Credentials:LMT LIC# MA38162
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9640 NW 7TH CIR APT 2023
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4999
Mailing Address - Country:US
Mailing Address - Phone:954-253-1381
Mailing Address - Fax:
Practice Address - Street 1:9640 NW 7TH CIR APT 2023
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4999
Practice Address - Country:US
Practice Address - Phone:954-253-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38162225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist