Healthcare Provider Details

I. General information

NPI: 1447354493
Provider Name (Legal Business Name): DEBORAH REID LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2699 STIRLING ROAD SUITE A 105
FT LAUDERDALE FL
33312
US

IV. Provider business mailing address

16701 NE 14TH AVE APT 301
NORTH MIAMI BEACH FL
33162-2854
US

V. Phone/Fax

Practice location:
  • Phone: 954-865-8310
  • Fax: 925-835-4250
Mailing address:
  • Phone: 305-944-9310
  • Fax: 925-835-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA47343
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: