Provider Demographics
NPI:1346495884
Name:LERMA, ROSE ANNA RENEE (LMT)
Entity Type:Individual
Prefix:MS
First Name:ROSE ANNA
Middle Name:RENEE
Last Name:LERMA
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 1:101 ENFIELD CT
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-3468
Mailing Address - Country:US
Mailing Address - Phone:936-662-7144
Mailing Address - Fax:
Practice Address - Street 1:101 ENFIELD COURT
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320
Practice Address - Country:US
Practice Address - Phone:936-662-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT102347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist