Provider Demographics
NPI:1194981399
Name:SAWYER, ANGELA DIANE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DIANE
Last Name:SAWYER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7743 NE 62ND WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-1331
Mailing Address - Country:US
Mailing Address - Phone:352-213-0072
Mailing Address - Fax:
Practice Address - Street 1:2727 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6632
Practice Address - Country:US
Practice Address - Phone:352-213-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist