Provider Demographics
NPI:1023361706
Name:MURRAY, ROSE (LMT)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 BULL ST
Mailing Address - Street 2:218
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2016
Mailing Address - Country:US
Mailing Address - Phone:912-401-8510
Mailing Address - Fax:
Practice Address - Street 1:3025 BULL ST. , #218
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:UM
Practice Address - Phone:912-401-8510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004736225700000X
SCMAS.5562225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist