Provider Demographics
NPI:1992930416
Name:RESTREPO, ANGELA (LMT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RESTREPO
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 1:1851 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3995
Mailing Address - Country:US
Mailing Address - Phone:561-401-3124
Mailing Address - Fax:561-881-2168
Practice Address - Street 1:1851 W INDIANTOWN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3995
Practice Address - Country:US
Practice Address - Phone:561-401-3124
Practice Address - Fax:561-881-2168
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA16517225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist