| Doctor Name: | ANOUSONE INTHIRATH |
| NPI Number: | 1972968287 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 151 Sawgrass Corners Dr Suite # 109 Ponte Vedra Beach, FL - 320823553 |
| Business Phone Number: | 9043714649 |
| Business Fax Number: | 8883931099 |
| Mailing Address: | 151 Sawgrass Corners Dr, Suite # 109 PONTE VEDRA BEACH |
| State: | FL |
| Postal Code: | 320823553 |
| Phone Number: | 9043714649 |
| Fax Number: | 8883931099 |
| NPI Enumeration Date: | 12/31/2015 |
| NPI Last Update Date: | 12/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| 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. |