Provider Demographics
NPI:1851339790
Name:CEROVSEK TORRES, TJASA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TJASA
Middle Name:
Last Name:CEROVSEK TORRES
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 1:5267 SW 97TH WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4163
Mailing Address - Country:US
Mailing Address - Phone:352-336-1792
Mailing Address - Fax:
Practice Address - Street 1:4833 SW 91ST TER
Practice Address - Street 2:SUITE O-102
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9109
Practice Address - Country:US
Practice Address - Phone:352-372-6550
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 42365225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist