Individual
HALLE AYANA CONQUEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8491 S US HIGHWAY 1 STE 15, PORT SAINT LUCIE, FL 34952-3360
(772) 251-9976
Mailing address
2010 SW BRISBANE ST, PORT SAINT LUCIE, FL 34984-4404
(772) 251-9976
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA96582
FL
Other
Enumeration date
03/25/2022
Last updated
03/25/2022
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