Healthcare Provider Details

I. General information

NPI: 1548475171
Provider Name (Legal Business Name): LYNDSI DAWN ROSEN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 WARRENSVILLE CENTER RD 121
SHAKER HTS OH
44122-5247
US

IV. Provider business mailing address

11240 CHEYENNE TRL B
PARMA HEIGHTS OH
44130-9021
US

V. Phone/Fax

Practice location:
  • Phone: 216-491-3883
  • Fax: 216-491-3884
Mailing address:
  • Phone: 216-337-8005
  • Fax: 216-491-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.012628
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: