Provider Demographics
NPI:1467812495
Name:WEBB, ANGEL (LMT)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:WEBB
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 1:136 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-3458
Mailing Address - Country:US
Mailing Address - Phone:229-516-3287
Mailing Address - Fax:
Practice Address - Street 1:136 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-3458
Practice Address - Country:US
Practice Address - Phone:229-516-3287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010977225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist