MEDICARE: TAKEISHA MICHELLE DORZILME

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
1	225700000X	Massage Therapist	MA98019	FL

General Provider Information

NPI Number	:	1710850615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKEISHA MICHELLE DORZILME

Provider Business Mailing Address
First Line	:	5818 BERMUDA CIR W
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6250 LANTANA RD STE 10
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6609
Country	:	US
Telephone Number	:	561-247-3628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2025
Last Update Date	:	09/26/2025

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