Individual
LISA MARIE IVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
142A DANIELSON PIKE, FOSTER, RI 02825-1475
(401) 241-1924
Mailing address
142A DANIELSON PIKE, FOSTER, RI 02825-1475
(401) 241-1924
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT00552
RI
Other
Enumeration date
03/09/2011
Last updated
03/09/2011
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