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General NPI Number Information
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NPI Number | 1710850615
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Entity Type | Individual
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Provider Name | TAKEISHA MICHELLE DORZILME
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Gender | Female
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Dates
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Enumeration Date | 09/26/2025
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 6250 LANTANA RD STE 10
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City | LAKE WORTH
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State | FL
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Zip | 33463-6609
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Country | US
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Telephone | 561-247-3628
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Fax |
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Provider Business Mailing Address
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Address Line | 5818 BERMUDA CIR W
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-1846
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Country | US
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Telephone |
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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 | MA98019
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License Number State | FL
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