Provider Demographics
NPI:1437440955
Name:SOUZA, DEBORA (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:SOUZA
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 1:210 JUPITER LAKES BLVD
Mailing Address - Street 2:SUITE 5101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7191
Mailing Address - Country:US
Mailing Address - Phone:561-741-1876
Mailing Address - Fax:888-721-1997
Practice Address - Street 1:210 JUPITER LAKES BLVD
Practice Address - Street 2:SUITE 5101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7191
Practice Address - Country:US
Practice Address - Phone:561-741-1876
Practice Address - Fax:888-721-1997
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 55928225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist