Provider Demographics
NPI:1508065954
Name:GILBERT, LESLEY-ANNE (LICENSED MASSAGE THE)
Entity Type:Individual
Prefix:MS
First Name:LESLEY-ANNE
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NE 104 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138
Mailing Address - Country:US
Mailing Address - Phone:305-759-9649
Mailing Address - Fax:
Practice Address - Street 1:4407 SHERIDAN STREET
Practice Address - Street 2:HOLISTIC MASSAGE & WELLNESS CLINIC
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-893-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA27091OtherMA27091