Doctor Name: | SUNRISE GERVAIS |
NPI Number: | 1730577982 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT |
License Number: | LMT 2560 |
Business Practice Address: | 1874 Slaughter Rd Suite M Madison, AL - 357585906 |
Business Phone Number: | 2564317672 |
Business Fax Number: | |
Mailing Address: | 212 S Clinton St, ATHENS |
State: | AL |
Postal Code: | 356112616 |
Phone Number: | 2564317672 |
Fax Number: | |
NPI Enumeration Date: | 12/22/2014 |
NPI Last Update Date: | 12/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | LMT 2560 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
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. |