Healthcare Provider Details

I. General information

NPI: 1972407799
Provider Name (Legal Business Name): ANNALIESE DANIELLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 NE 6TH CT APT 401
BOYNTON BEACH FL
33435-3926
US

IV. Provider business mailing address

689 NE 6TH CT APT 401
BOYNTON BEACH FL
33435-3926
US

V. Phone/Fax

Practice location:
  • Phone: 561-543-3165
  • Fax:
Mailing address:
  • Phone: 561-543-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA96622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: