Provider Demographics
NPI:1992109821
Name:CURRAN, ANGIE (LMT)
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:
Last Name:CURRAN
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 1:6785 LYNNHURST LN
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-9628
Mailing Address - Country:US
Mailing Address - Phone:815-742-4410
Mailing Address - Fax:
Practice Address - Street 1:4186 N PERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-8647
Practice Address - Country:US
Practice Address - Phone:815-398-7264
Practice Address - Fax:815-229-7264
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227006090225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist