Provider Demographics
NPI:1972729788
Name:ROSE, AVI (LICENSED MASSAGE THE)
Entity Type:Individual
Prefix:MR
First Name:AVI
Middle Name:
Last Name:ROSE
Suffix:
Gender:M
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315
Mailing Address - Country:US
Mailing Address - Phone:954-522-3212
Mailing Address - Fax:
Practice Address - Street 1:570 OCEAN DRIVE
Practice Address - Street 2:HOLISTIC MASSAGE & WELLNESS CLINICS #501
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408
Practice Address - Country:US
Practice Address - Phone:954-491-2225
Practice Address - Fax:954-491-6862
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA32722OtherLICENSE NUMBER