Provider Demographics
NPI:1487482675
Name:VANDEGRIFT, ANGELA (LMT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:VANDEGRIFT
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 1:6201 JOHNSON DR APT 332
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3473
Mailing Address - Country:US
Mailing Address - Phone:785-766-8642
Mailing Address - Fax:
Practice Address - Street 1:6556 JOHNSON DR # 332
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2615
Practice Address - Country:US
Practice Address - Phone:785-766-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist