Doctor Name: | MRS. LARA FLEISCHAKER FASS |
NPI Number: | 1861736811 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | B.A., LMBT, LE |
License Number: | 2158 |
Business Practice Address: | 17039 Kenton Dr. Suite 104 Cornelius, NC - 28031 |
Business Phone Number: | 7048962889 |
Business Fax Number: | |
Mailing Address: | 519 Delburg St., Davidson DAVIDSON |
State: | NC |
Postal Code: | 28036 |
Phone Number: | 7042018653 |
Fax Number: | |
NPI Enumeration Date: | 11/15/2012 |
NPI Last Update Date: | 11/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 2158 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
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. |