Provider Demographics
NPI:1689982746
Name:EGEA, LUISA F (LMT)
Entity Type:Individual
Prefix:MISS
First Name:LUISA
Middle Name:F
Last Name:EGEA
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 1:401 LAKEVIEW DR
Mailing Address - Street 2:BLDG# 70 APT# 205
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2404
Mailing Address - Country:US
Mailing Address - Phone:954-821-2420
Mailing Address - Fax:
Practice Address - Street 1:5169 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-4508
Practice Address - Country:US
Practice Address - Phone:954-821-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47652173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist