Provider Demographics
NPI:1558057836
Name:VINCENT, ROSE-PAULA (LMT)
Entity Type:Individual
Prefix:
First Name:ROSE-PAULA
Middle Name:
Last Name:VINCENT
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 1:450 NE 114TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6651
Mailing Address - Country:US
Mailing Address - Phone:786-399-4261
Mailing Address - Fax:
Practice Address - Street 1:9999 NE 2ND AVE STE 218
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2345
Practice Address - Country:US
Practice Address - Phone:305-756-3940
Practice Address - Fax:305-756-3970
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA89908225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist