MEDICARE: DANIELLE EROSA LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146L00000X	Paramedic	P57973538	AZ
2	225700000X	Massage Therapist	MT-29449	AZ

General Provider Information

NPI Number	:	1487413480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE EROSA LMT

Provider Business Mailing Address
First Line	:	1521 E EMERALD AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-4327
Country	:	US
Telephone Number	:	602-582-8652
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 E EMERALD AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-4327
Country	:	US
Telephone Number	:	602-582-8652
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	05/16/2024

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Directions to “ DANIELLE EROSA LMT” Practice Location

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