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General NPI Number Information
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NPI Number | 1811687296
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Entity Type | Organization
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Legal Business Name | ELIZA LLC
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 21HI WESTERN AVE
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City | KENNEBUNK
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State | ME
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Zip | 04043
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Country | US
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Telephone | 207-313-9114
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 282
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City | SACO
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State | ME
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Zip | 04072-0282
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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 | OWNER
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Name | MS. ELIZABETH MICHEA DANINE CONLEY-LEPENE
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Credential |
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Telephone | 207-480-9183
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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 |
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License Number State |
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