Healthcare Provider Details

I. General information

NPI: 1922556075
Provider Name (Legal Business Name): ROSANNA POUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 S HOUSTON LAKE RD STE # 2
WARNER ROBINS GA
31088-8017
US

IV. Provider business mailing address

158 S HOUSTON LAKE RD STE # 2
WARNER ROBINS GA
31088-8017
US

V. Phone/Fax

Practice location:
  • Phone: 850-264-3768
  • Fax:
Mailing address:
  • Phone: 850-264-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: