Provider Demographics
NPI:1386965317
Name:CONEY, ANGELA MARIE (LMT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:CONEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8303 FORT WALTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-1397
Mailing Address - Country:US
Mailing Address - Phone:772-429-1149
Mailing Address - Fax:772-429-1149
Practice Address - Street 1:1360 US HIGHWAY 1
Practice Address - Street 2:SUITE 5
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5703
Practice Address - Country:US
Practice Address - Phone:772-569-7770
Practice Address - Fax:772-569-7770
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 50066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 50066OtherSTATE OF FLORIDA LICENSE NUMBER FOR MASSAGE THERAPIST