Provider Demographics
NPI:1285980516
Name:SEALS, ANGEL ANN (LMT)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:ANN
Last Name:SEALS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1989
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32655-1989
Mailing Address - Country:US
Mailing Address - Phone:352-359-0761
Mailing Address - Fax:
Practice Address - Street 1:1212 NW 12TH AVE
Practice Address - Street 2:SUITE C-3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3032
Practice Address - Country:US
Practice Address - Phone:352-359-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA68212225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist