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General NPI Number Information
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NPI Number | 1619356532
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Entity Type | Individual
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Provider Name | GUADALUPE JESSICA ROBERTS LMT
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Gender | Female
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 5841 S CONGRESS AVE
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City | ATLANTIS
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State | FL
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Zip | 33462-1347
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Country | US
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Telephone | 561-214-9217
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 VILLAGE BLVD APT 1826
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-2793
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Country | US
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Telephone | 561-714-5584
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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 | MA68383
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License Number State | FL
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