Healthcare Provider Details

I. General information

NPI: 1376287409
Provider Name (Legal Business Name): DENISE MARIE PLOURDE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 TEXAS ST
ENGLEWOOD FL
34223-2441
US

IV. Provider business mailing address

941 TEXAS ST
ENGLEWOOD FL
34223-2441
US

V. Phone/Fax

Practice location:
  • Phone: 860-978-8574
  • Fax:
Mailing address:
  • Phone: 860-978-8574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number008473
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: