Provider Demographics
NPI:1386798270
Name:HESTER, ANGELA D (RMT, NCBTMB)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:HESTER
Suffix:
Gender:F
Credentials:RMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 COUNTY ROAD 392
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:MS
Mailing Address - Zip Code:38873-9107
Mailing Address - Country:US
Mailing Address - Phone:662-438-9930
Mailing Address - Fax:
Practice Address - Street 1:3001 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9399
Practice Address - Country:US
Practice Address - Phone:662-287-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist