Healthcare Provider Details

I. General information

NPI: 1932034196
Provider Name (Legal Business Name): REBECCA DESOTO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 LAKEBEND DR
DAYTON OH
45404-2134
US

IV. Provider business mailing address

3821 LAKEBEND DR
DAYTON OH
45404-2134
US

V. Phone/Fax

Practice location:
  • Phone: 937-236-1705
  • Fax: 937-236-1735
Mailing address:
  • Phone: 937-236-1705
  • Fax: 937-236-1735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.027338
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: