Healthcare Provider Details

I. General information

NPI: 1003625393
Provider Name (Legal Business Name): KRISTY ROSE GARNEAU LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 STEVENS AVE
PORTLAND ME
04103-3068
US

IV. Provider business mailing address

119 MORNING ST APT 17
PORTLAND ME
04101-3268
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-5868
  • Fax: 207-797-5498
Mailing address:
  • Phone: 207-890-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: