Provider Demographics
NPI:1326247743
Name:STRESAU, KAREN LYN (LMT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYN
Last Name:STRESAU
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 1:700 E LINCOLN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4800
Mailing Address - Country:US
Mailing Address - Phone:321-543-8587
Mailing Address - Fax:
Practice Address - Street 1:700 E LINCOLN AVE STE 1
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4800
Practice Address - Country:US
Practice Address - Phone:321-543-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL44244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist