Provider Demographics
NPI:1477758647
Name:LAVENTURE, DENISE MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:LAVENTURE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:635 PAULA AVE
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-6118
Mailing Address - Country:US
Mailing Address - Phone:321-454-9200
Mailing Address - Fax:321-576-0054
Practice Address - Street 1:925 N COURTENAY PKWY
Practice Address - Street 2:SUITE 6
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4569
Practice Address - Country:US
Practice Address - Phone:321-454-9200
Practice Address - Fax:321-576-0054
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-24503225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist