Healthcare Provider Details

I. General information

NPI: 1932573078
Provider Name (Legal Business Name): REBECCA LIEBERMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2015
Last Update Date: 11/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34921 US HIGHWAY 19 N # 150
PALM HARBOR FL
34684-1969
US

IV. Provider business mailing address

39650 US HIGHWAY 19 N APT 736
TARPON SPGS FL
34689-3912
US

V. Phone/Fax

Practice location:
  • Phone: 561-318-1115
  • Fax:
Mailing address:
  • Phone: 561-318-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA34918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: