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General NPI Number Information
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NPI Number | 1558641480
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Entity Type | Individual
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Provider Name | LAURA MEJIA LMT
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Gender | Female
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 613 SE CENTRAL PKWY
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City | STUART
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State | FL
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Zip | 34994-3984
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Country | US
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Telephone | 772-631-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 SW SILVER PINE WAY 109-C2
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City | PALM CITY
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State | FL
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Zip | 34990-4732
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Country | US
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Telephone | 772-631-2400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA57955
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License Number State | FL
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