Provider Demographics
NPI:1518774280
Name:THOMPSON, ANGELA MARIE (MT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-2627
Mailing Address - Country:US
Mailing Address - Phone:605-305-2336
Mailing Address - Fax:
Practice Address - Street 1:111 W 39TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5732
Practice Address - Country:US
Practice Address - Phone:605-271-3578
Practice Address - Fax:507-532-2399
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT12032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist