Healthcare Provider Details

I. General information

NPI: 1174457733
Provider Name (Legal Business Name): LACRESHA ANQUENNETTE RAMOS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E INTERNATIONAL SPEEDWAY BLVD STE 114
DAYTONA BEACH FL
32118-4662
US

IV. Provider business mailing address

1296 SAND TRAP CT
DAYTONA BEACH FL
32124-3022
US

V. Phone/Fax

Practice location:
  • Phone: 386-286-4481
  • Fax:
Mailing address:
  • Phone: 903-462-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA91314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: