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General NPI Number Information
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NPI Number | 1801247499
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Entity Type | Individual
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Provider Name | LARYSSA HERBERT LMT
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Gender | Female
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Dates
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Enumeration Date | 06/25/2016
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 1260 W BAY DR STE A
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City | LARGO
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State | FL
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Zip | 33770-2249
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Country | US
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Telephone | 727-755-7982
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Fax |
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Provider Business Mailing Address
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Address Line | 14345 90TH AVE
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City | SEMINOLE
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State | FL
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Zip | 33776-1923
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Country | US
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Telephone | 615-828-3112
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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 | MA78610
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License Number State | FL
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