Provider Demographics
NPI:1255504197
Name:SMITH, DENISE ANGELITA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ANGELITA
Last Name:SMITH
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 1:1470 NW 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3947
Mailing Address - Country:US
Mailing Address - Phone:954-956-8555
Mailing Address - Fax:954-974-1266
Practice Address - Street 1:1470 NW 47TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3947
Practice Address - Country:US
Practice Address - Phone:954-956-8555
Practice Address - Fax:954-974-1266
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31477225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist