Provider Demographics
NPI:1447369137
Name:ROBERSON, ANGELA KRISTINA (LMP)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:KRISTINA
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 GONZAGA CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6236
Mailing Address - Country:US
Mailing Address - Phone:360-915-6540
Mailing Address - Fax:
Practice Address - Street 1:3439 GONZAGA CT SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6236
Practice Address - Country:US
Practice Address - Phone:360-915-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0204464OtherDEPT OF L&I