Provider Demographics
NPI:1831229087
Name:KARVETSKY, PHYLLIS (LMT)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:
Last Name:KARVETSKY
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 1:919 DOLPHIN AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-5119
Mailing Address - Country:US
Mailing Address - Phone:772-388-5652
Mailing Address - Fax:772-998-7997
Practice Address - Street 1:777 37TH ST
Practice Address - Street 2:B106
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4873
Practice Address - Country:US
Practice Address - Phone:772-299-4325
Practice Address - Fax:772-998-7997
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48636225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist