Doctor Name: | MS. THALIA LAEL MICAH |
NPI Number: | 1013274463 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | MA65758 |
Business Practice Address: | 350 12th Rd Apt 107 Vero Beach, FL - 329607645 |
Business Phone Number: | 7723329885 |
Business Fax Number: | |
Mailing Address: | 350 12th Rd # 107, VERO BEACH |
State: | FL |
Postal Code: | 32960 |
Phone Number: | 7723329885 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2012 |
NPI Last Update Date: | 04/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA65758 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |