Healthcare Provider Details

I. General information

NPI: 1518260017
Provider Name (Legal Business Name): DAWN CILIBERTO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 CHERRY BLOSSOM CT UNIT 102
ESTERO FL
33928-4907
US

IV. Provider business mailing address

3524 CHERRY BLOSSOM CT UNIT 102
ESTERO FL
33928-4907
US

V. Phone/Fax

Practice location:
  • Phone: 941-662-0526
  • Fax:
Mailing address:
  • Phone: 941-662-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number50672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: