Provider Demographics
NPI:1346950284
Name:MISCO, DESIREE BETH (LMT)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:BETH
Last Name:MISCO
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 1:142 MAIN ST RM 500
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2798
Mailing Address - Country:US
Mailing Address - Phone:603-490-5481
Mailing Address - Fax:
Practice Address - Street 1:142 MAIN ST RM 500
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2798
Practice Address - Country:US
Practice Address - Phone:603-490-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3565M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist