Individual
LISA WIECZOREK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
17604 90TH ST N, LOXAHATCHEE, FL 33470-2631
(561) 602-9990
(561) 333-5939
Mailing address
17604 90TH ST N, LOXAHATCHEE, FL 33470-2631
(561) 602-9990
(561) 333-5939
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 21717
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
677392396
—
FL
Enumeration date
08/30/2006
Last updated
07/09/2007
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