Provider Demographics
NPI:1053987107
Name:HOLDER, ANGELA MICHELLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MICHELLE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:711 NEW HIGHWAY 68 STE C
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-1926
Mailing Address - Country:US
Mailing Address - Phone:423-596-5504
Mailing Address - Fax:
Practice Address - Street 1:711 NEW HIGHWAY 68 STE C
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-1926
Practice Address - Country:US
Practice Address - Phone:423-596-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12625225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty