Provider Demographics
NPI:1467683201
Name:VASALLO, LAURA (AP, LMT)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:VASALLO
Suffix:
Gender:F
Credentials:AP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W HIBISCUS BLVD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2718
Mailing Address - Country:US
Mailing Address - Phone:321-725-2438
Mailing Address - Fax:321-725-8969
Practice Address - Street 1:1101 W HIBISCUS BLVD
Practice Address - Street 2:SUITE #105
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2718
Practice Address - Country:US
Practice Address - Phone:321-725-2438
Practice Address - Fax:321-725-8969
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1422171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist