Provider Demographics
NPI:1861087009
Name:HEATH, ANGELA DAWN
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:HEATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S 1990 E APT 425
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5081
Mailing Address - Country:US
Mailing Address - Phone:252-290-2050
Mailing Address - Fax:
Practice Address - Street 1:514 S 1990 E APT 425
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5081
Practice Address - Country:US
Practice Address - Phone:252-290-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist