Individual
LISA MARIE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11203 NEWPORT SOUND PL, NEW SMYRNA BEACH, FL 32168-7591
(386) 215-6471
Mailing address
11203 NEWPORT SOUND PL, NEW SMYRNA BEACH, FL 32168-7591
(386) 215-6471
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA95742
FL
Other
Enumeration date
10/04/2020
Last updated
10/04/2020
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