Provider Demographics
NPI:1205548963
Name:PESINA, IVY (NCLMBT)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:PESINA
Suffix:
Gender:F
Credentials:NCLMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LENA ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-6263
Mailing Address - Country:US
Mailing Address - Phone:828-527-8144
Mailing Address - Fax:
Practice Address - Street 1:551 BURMA RD W
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5583
Practice Address - Country:US
Practice Address - Phone:828-527-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18533225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist