Provider Demographics
NPI:1922707397
Name:BANDIN, DESDEMORA CELESTINA (LMT)
Entity Type:Individual
Prefix:
First Name:DESDEMORA
Middle Name:CELESTINA
Last Name:BANDIN
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 1:6547 SW 152ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-8930
Mailing Address - Country:US
Mailing Address - Phone:772-501-1007
Mailing Address - Fax:
Practice Address - Street 1:6547 SW 152ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-8930
Practice Address - Country:US
Practice Address - Phone:772-501-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA97145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA97145OtherLICENSED MASSAGE THERAPIST