Provider Demographics
NPI:1093246134
Name:MINERVINI, DARA LAUREN (LMT)
Entity Type:Individual
Prefix:MS
First Name:DARA
Middle Name:LAUREN
Last Name:MINERVINI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4909 NW 27TH CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6509
Mailing Address - Country:US
Mailing Address - Phone:352-377-6008
Mailing Address - Fax:352-377-7364
Practice Address - Street 1:4909 NW 27TH CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6509
Practice Address - Country:US
Practice Address - Phone:352-377-6008
Practice Address - Fax:352-377-7364
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA83290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist