Individual
LANISDAY BASULTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3762 TAMIAMI TRL STE G, PORT CHARLOTTE, FL 33952-8363
(786) 715-4720
Mailing address
4543 OAKLEY RD, NORTH PORT, FL 34288-2360
(786) 715-4720
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA107301
FL
Other
Enumeration date
07/10/2025
Last updated
07/10/2025
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