Healthcare Provider Details

I. General information

NPI: 1053232991
Provider Name (Legal Business Name): EDWARD VINCENT PEARSAUL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ORANGE AVE STE 208
FORT PIERCE FL
34950-4304
US

IV. Provider business mailing address

1433 32ND AVE SW
VERO BEACH FL
32968-5904
US

V. Phone/Fax

Practice location:
  • Phone: 772-321-9646
  • Fax:
Mailing address:
  • Phone: 772-321-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA28746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: