Individual
MALISSA M BORDELON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7198 BEATLINE RD, SUITE A, LONG BEACH, MS 39560-9146
(228) 868-9799
Mailing address
PO BOX 8864, GULFPORT, MS 39506-8864
(228) 223-7400
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1861
MS
Other
Enumeration date
07/05/2011
Last updated
07/05/2011
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