Provider Demographics
NPI:1467902429
Name:DELAGRACIA, DONA (LMT)
Entity Type:Individual
Prefix:
First Name:DONA
Middle Name:
Last Name:DELAGRACIA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:DONA
Other - Middle Name:
Other - Last Name:DELAGRACIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3870 DAIRY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7605
Mailing Address - Country:US
Mailing Address - Phone:321-373-2100
Mailing Address - Fax:844-272-1733
Practice Address - Street 1:3870 DAIRY RD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-7605
Practice Address - Country:US
Practice Address - Phone:321-373-2100
Practice Address - Fax:844-272-1733
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA69976225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist