MEDICARE: SABINE DESSOURCES 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
1	225700000X	Massage Therapist	MA44065	FL

General Provider Information

NPI Number	:	1770896383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABINE DESSOURCES LMT

Provider Business Mailing Address
First Line	:	365 NW 129TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-3701
Country	:	US
Telephone Number	:	786-227-0614
Fax Number	:

Provider Business Practice Location Address
First Line	:	365 NW 129TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-3701
Country	:	US
Telephone Number	:	305-685-8439
Fax Number	:

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

Provider Enumeration Date	:	07/24/2010
Last Update Date	:	05/04/2024

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Directions to “ SABINE DESSOURCES LMT” Practice Location

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