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General NPI Number Information
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NPI Number | 1982195327
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Entity Type | Individual
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Provider Name | DAVID J DE SOUSA LMT
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Gender | Male
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 22 UPPER MILE POINT RD WELLNESS CENTER
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City | MEREDITH
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State | NH
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Zip | 03253-5741
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Country | US
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Telephone | 603-387-0950
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Fax |
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Provider Business Mailing Address
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Address Line | 12 POTTING BENCH RD
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City | MEREDITH
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State | NH
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Zip | 03253-4212
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Country | US
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Telephone | 603-387-0950
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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 | 4052
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 8782
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License Number State | LA
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