Healthcare Provider Details

I. General information

NPI: 1588825889
Provider Name (Legal Business Name): MONICA SHANE MONROE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 HIGHLAND AVE
VERO BEACH FL
32960-3662
US

IV. Provider business mailing address

956 37TH AVE
VERO BEACH FL
32960-4056
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-4002
  • Fax:
Mailing address:
  • Phone: 772-774-9326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA42258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: