Angel Mallett

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

7501015565 Issued in MI

Practice address

2800 W Grand Blvd
Detroit, MI 48202-2610

Phone

(313) 506-2552

NPI assigned

Nov 11, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1356165054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3622 E WILLIS ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482071804",
            "telephone_number": "313-506-2552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022610",
            "telephone_number": "313-506-2552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6201 2nd Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482023405",
            "country_code": "US",
            "telephone_number": "313-506-2552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLETT",
        "first_name": "ANGEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-11",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501015565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Maliszewski
• Shreya Mallajosyula, OD
• Sravya Mallajosyula, DO
• James Philip A Mallare, CHES
• Latonya E. Mallett-McLemore, MA, LLPC, CDF
• Imaad Uddin Mallick, M.D
• Ashley Renee Malliett
• Adrienne Maria Mallory
• Ceola Mallory
• Gabriella Alexzandria Mallory

• Massage Therapist in Detroit, MI
• Providers in Detroit, MI by specialty
• Massage Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.