Healthcare Provider Details

I. General information

NPI: 1659417368
Provider Name (Legal Business Name): MAURA R NORMAN L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAURA R NORMAN L.M.T.

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 N COUNTRY CLUB DR SUITE 2110
AVENTURA FL
33180-1729
US

IV. Provider business mailing address

3625 N COUNTRY CLUB DR SUITE 2110
AVENTURA FL
33180-1729
US

V. Phone/Fax

Practice location:
  • Phone: 305-962-3668
  • Fax: 954-963-7169
Mailing address:
  • Phone: 305-962-3668
  • Fax: 954-963-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA23723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: