Individual
MS. LARISA PAVLOVNA PETROVA-POLLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
416 HECLA ST, LAURIUM, MI 49913-2212
(906) 337-1718
Mailing address
416 HECLA ST, LAURIUM, MI 49913-2212
(906) 337-1718
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
N/C-18/00
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N/C-18/00
RUSSION CERTIFICATE
—
Enumeration date
08/18/2011
Last updated
08/18/2011
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