Provider Demographics
NPI:1861937708
Name:FRANCOM, ANGELA (LMT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:FRANCOM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:BAYNES
Other - Last Name:TACHENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:419 E REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2225
Mailing Address - Country:US
Mailing Address - Phone:612-206-2895
Mailing Address - Fax:
Practice Address - Street 1:329 E 300 S
Practice Address - Street 2:STE 102
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2752
Practice Address - Country:US
Practice Address - Phone:612-206-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT84785564701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist