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NPI Code Detail

MEDICARE: MISS ELIZABETH M FRAGELLO LMT

MEDICARE: MISS ELIZABETH M FRAGELLO LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistLMT-1758MS

General Provider Information

NPI Number : 1144587338
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ELIZABETH M FRAGELLO LMT
Provider Business Mailing Address
First Line : 10365 GORENFLO RD
Second Line : APT 1414
City : DIBERVILLE
State : MS
Zip : 39540-2735
Country : US
Telephone Number : 228-669-9040
Fax Number :
Provider Business Practice Location Address
First Line : 1800 BEACH DR
Second Line :
City : GULFPORT
State : MS
Zip : 39507-1553
Country : US
Telephone Number : 228-669-9040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2012
Last Update Date : 04/12/2012

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Directions to “ MISS ELIZABETH M FRAGELLO LMT” Practice Location

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