Provider Demographics
NPI:1548435613
Name:LAGRAVE, ANGELE MARGARITA (LMT)
Entity type:Individual
Prefix:
First Name:ANGELE
Middle Name:MARGARITA
Last Name:LAGRAVE
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 1:2016 DELTA BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4897
Mailing Address - Country:US
Mailing Address - Phone:850-878-4434
Mailing Address - Fax:850-878-4423
Practice Address - Street 1:2016 DELTA BLVD
Practice Address - Street 2:STE 100
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4897
Practice Address - Country:US
Practice Address - Phone:850-878-4434
Practice Address - Fax:850-878-4423
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA15381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA15381OtherFLORIDA LICENSE