Provider Demographics
NPI:1891017968
Name:BRISENO, SALINA (LMT)
Entity Type:Individual
Prefix:
First Name:SALINA
Middle Name:
Last Name:BRISENO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SAINA
Other - Middle Name:BRISENO
Other - Last Name:KIKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4815 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3922
Mailing Address - Country:US
Mailing Address - Phone:352-359-6628
Mailing Address - Fax:
Practice Address - Street 1:2126 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3524
Practice Address - Country:US
Practice Address - Phone:352-359-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57089225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist