Provider Demographics
NPI:1558567768
Name:LAVASSEUR, ADELE (LMT)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:
Last Name:LAVASSEUR
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 1:104 COLLEGE DR
Mailing Address - Street 2:SUITE2
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-3300
Mailing Address - Country:US
Mailing Address - Phone:904-213-1400
Mailing Address - Fax:
Practice Address - Street 1:104 COLLEGE DR
Practice Address - Street 2:SUITE2
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-3300
Practice Address - Country:US
Practice Address - Phone:904-213-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA22823225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist