Individual
LARISSA JAE TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4111 E VALLEY AUTO DR STE 209, MESA, AZ 85206-4609
(480) 401-7495
Mailing address
1511 E MOON VISTA ST, APACHE JUNCTION, AZ 85119-9632
(480) 401-7495
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-24487
AZ
Other
Enumeration date
07/26/2024
Last updated
07/26/2024
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