Provider Demographics
NPI:1285871699
Name:BROWN, ANGELA LEAH (LMP)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:LEAH
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1031
Mailing Address - Country:US
Mailing Address - Phone:360-373-1217
Mailing Address - Fax:
Practice Address - Street 1:603 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1266
Practice Address - Country:US
Practice Address - Phone:360-377-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60012520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist