Individual
LISA MARY MACGOVERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
55 VINING CT APT 113, ORMOND BEACH, FL 32176-6676
(386) 673-1041
Mailing address
190 VINING CT, ORMOND BEACH, FL 32176-6658
(386) 673-1041
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA35780
FL
Other
Enumeration date
06/02/2014
Last updated
06/02/2014
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