Individual
MISS DESIRAE MADISON GAVIDIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, MMP
Contact information
Practice address
555 COLORADO AVE, SUITE 111, STUART, FL 34994-3025
(772) 497-6126
Mailing address
501 SW TIMBER TRL, STUART, FL 34997-6266
(772) 497-6126
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA65422
FL
Other
Enumeration date
10/04/2013
Last updated
10/04/2013
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