Individual
LAURIE BEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
101 N ISABELLA ST, SUITE C, SYLVESTER, GA 31791-2199
(229) 821-3178
Mailing address
101 N ISABELLA ST, SUITE C, SYLVESTER, GA 31791-2199
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT010986
GA
Other
Enumeration date
07/05/2016
Last updated
07/05/2016
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