Provider Demographics
NPI:1316187396
Name:MANZZO, JULISSA E (LMT)
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:E
Last Name:MANZZO
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 1:2648 W STATE ROAD 434
Mailing Address - Street 2:SUITE C
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4440
Mailing Address - Country:US
Mailing Address - Phone:407-788-7778
Mailing Address - Fax:407-788-7770
Practice Address - Street 1:2648 W STATE ROAD 434
Practice Address - Street 2:SUITE C
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4440
Practice Address - Country:US
Practice Address - Phone:407-788-7778
Practice Address - Fax:407-788-7770
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist