Provider Demographics
NPI:1457995383
Name:ADAMS, ELIZABETH ROSALIE (LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROSALIE
Last Name:ADAMS
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 1:12719 ROLLING BROAK CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7468
Mailing Address - Country:US
Mailing Address - Phone:407-574-0792
Mailing Address - Fax:407-855-0409
Practice Address - Street 1:100 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5409
Practice Address - Country:US
Practice Address - Phone:407-574-0792
Practice Address - Fax:407-855-0409
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA91952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist