Provider Demographics
NPI:1649914649
Name:ROSARIO, JASMINE LORRAINE (LMBT-MLD)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LORRAINE
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:LMBT-MLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 AUGUSTUS BEAMON DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-0390
Mailing Address - Country:US
Mailing Address - Phone:704-989-1616
Mailing Address - Fax:
Practice Address - Street 1:124 UNIONVILLE INDIAN TRAIL RD W STE A7
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5595
Practice Address - Country:US
Practice Address - Phone:704-989-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist